Percutaneous Transcatheter Left Atrial Appendage Closure Devices: Role in the Long-Term Management of Atrial Fibrillation

Abstract

Atrial fibrillation remains the most common cardiac rhythmic disorder worldwide and is associated with significant health hazards, most notably an increase in the rate of cerebrovascular events. Stroke prevention in atrial fibrillation has traditionally been managed with warfarin therapy which is encumbered by risk of bleeding, drug administration logistics and interactions as well as issues of non-compliance. Occlusion of the left atrial appendage has recently been explored as an alternative method of stroke prevention. The aim of this article is to evaluate the history, efficacy and draw-backs associated with percutaneous left atrial appendage occlusion devices in the management of atrial fibrillation. The current literature and clinical experience was used to summarise the history and evaluate the efficacy of percutaneous left atrial appendage occlusion devices. Percutaneous left atrial appendage occlusion devices are effective novel therapies for stroke prevention in atrial fibrillation, with proven reductions in thromboembolic events in comparison with placebo and non-inferiority with warfarin therapy. Pericardial effusions and embolic strokes are primary peri-procedural adverse reactions. The rates of adverse reactions reduce with operator experience. Percutaneous left atrial appendage occlusion is an exciting and novel therapy of stroke prevention in atrial fibrillation. Whilst further trials and long-term data are required prior to widespread implementation of this procedure, trials so far have highlighted the clinical efficacy of the procedure.