Left atrial appendage exclusion: state-of-the-art.
It is postulated that the source of thromboembolism in 90% of patients with non-valvular atrial fibrillation (AF) arises from the left atrial appendage (LAA). Anticoagulation with warfarin is the standard medical therapy for stroke prevention in patients with AF. However, chronic warfarin therapy is contraindicated in 14 to 44% of patients with AF who are at risk for stroke. Mechanical exclusion of the LAA may prevent thrombus formation in the appendage and hence reduce the risk of stroke. Recently, several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices such as the PLAATO device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to warfarin therapy for selected patients. This article aims to review the current evidence for LAA exclusion in patients with AF.
Cruz-Gonzalez
Ignacio
I
Cardiology Division, University Hospital of Salamanca, Salamanca, Spain. cruzgonzalez.ignacio@gmail.com
Yan
Bryan P
BP
Lam
Yat-Yin
YY
D000284:Administration, Oral; D020517:Atrial Appendage / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D011859:Radiography; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents