Left atrial appendage occlusion in patients with atrial fibrillation: focus on current evidence and commercially available devices

Matteo Maurina,Antonio Mangieri,Martina Briani,Letizia Bertoldi,Paolo Pagnotta,Alessandro Villaschi,Mauro Chiarito,Damiano Regazzoli,Fabio Fazzari,Bernhard Reimers,Carlo Andrea Pivato

doi:10.20517/2574-1225.2021.88

Abstract

Left atrial appendage occlusion in patients with atrial fibrillation: focus on current evidence and commercially available devices

Highlights

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with cerebral or systemic embolization as a result of possible thrombus formation in the left atrium and left atrial appendage (LAA)[1]
Percutaneous and surgical techniques have been developed over the years to exclude the LAA and prevent systemic embolization in AF
Five-year outcomes of these two trials demonstrated that LAA occlusion provides stroke prevention in nonvalvular AF comparable to warfarin, with significant reductions in major bleedings and all-cause mortality (HR = 0.48; P = 0.0003 and HR = 0.73; P = 0.035, respectively)[16]

Summary

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with cerebral or systemic embolization as a result of possible thrombus formation in the left atrium and left atrial appendage (LAA)[1]. Anticoagulation has been shown to reduce the risk of embolization in AF[3,4]. In patients with high bleeding risk who are not candidates for anticoagulation, a different approach should be evaluated. Due to its anatomical characteristics and low-flow state predisposing to blood stasis and thrombosis, most atrial thrombi form in the LAA[5]. For this reason, percutaneous and surgical techniques have been developed over the years to exclude the LAA and prevent systemic embolization in AF. The purpose of this paper is to make an overview of the current state of LAAO procedure, with a focus on available devices and future perspectives

Objectives

Findings

Conclusion