Cierre percutáneo de la auriculilla izquierda en el manejo de la fibrilación auricular

Abstract

Nonvalvular atrial fibrillation is the most common arrhythmia in daily clinical practice. Its prevalence increases significantly with age. Likewise, patients with this condition are at high risk of developing cerebrovascular events, especially ischemic ones, usually of cardio-embolic origin, arising from the left atrial appendage in more than 90% of cases. The cornerstone of treatment in patients with nonvalvular atrial fibrillation is anticoagulation (to prevent the risk of a cerebrovascular accident), according to the risk classification for presenting an ischemic event vs. the risk of bleeding associated with the anticoagulation treatment. While, historically, warfarin has been used for this purpose, new oral anticoagulants have been developed recently which have proven to not be inferior in risk prevention, with a reasonable safety profile, but with a persistent probability of bleeds, particularly intracerebral and life-threatening bleeds.Based on the recognition of the left atrial appendage as the principle source of thrombi in patients with nonvalvular atrial fibrillation, percutaneous closure of the left atrial appendage, using a device, has emerged as a safe and effective option for preventing the risk of cerebrovascular accidents in patients for whom anticoagulant therapy is contraindicated, and/or who have difficulty in accessing health services.