Abstract
To date, left atrial appendage closure (LAAC) devices continue to be assessed as an intuitive alternative to oral anticoagulant therapy to prevent embolic complications in patients with atrial fibrillation. Concerns remain about the up-front risks associated with device implantation as well as device efficacy in preventing embolic events as compared with anticoagulation. Currently, LAAC devices serve as a potential alternative to long-term anticoagulation with the benefit of decreased bleeding risk but with less protection against ischemic events. An individualized risk–benefit analysis with regard to stroke possibility, bleeding likelihood with long-term anticoagulation, the risks of an invasive procedure, and the risks associated with having a lifelong intracardiac device should be performed to guide careful patient selection for this operation.
Highlights
left atrial appendage (LAA) closure (LAAC) devices are being assessed in an ongoing manner as an intuitive alternative to oral anticoagulant (OAC) therapy to prevent embolic events while lessening the risk of hemorrhagic complications
Percutaneous approaches to LAAC include implantable devices that occlude the LAA orifice, such as the WATCHMANTM device (Boston Scientific Corp., Natick, MA, USA) and the AMPLATZERTM AmuletTM (Abbott Laboratories, Chicago, IL, USA) as well as the LARIAT® device (SentreHEART, Redwood City, CA, USA), a soft-tissue snare that cinches the LAA epicardially
The Food and Drug Administration (FDA) indication for this device is to reduce the risk of thromboembolism from the LAA in patients with nonvalvular atrial fibrillation (AF) (NVAF) who (1) are at increased risk for stroke and are recommended for anticoagulation therapy, (2) do not have a contraindication to warfarin, and (3) have an appropriate reason to seek a nonpharmacologic alternative to warfarin.[9]
Summary
Left Atrial Appendage Closure: A Safe and Effective Alternative to Anticoagulation?. MARGARET M. LUSTGARTEN, md, phd[1,2]
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