title: Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation.
abstract: Atrial fibrillation is the most common cardiac arrhythmia, and its prevalence is increasing. Cardioembolic stroke, most of the times secondary to thrombus formation in the left atrial appendage, is its most feared and life threatening consequence. Oral anticoagulation with vitamin-K-antagonists is currently the most used prophylaxis for stroke in patients with atrial fibrillation; unfortunately, its benefits are limited by a narrow therapeutic window and an increased risk for bleeding, making it often undesired. Percutaneous occlusion of the left atrial appendage is a novel alternative strategy for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for long-term oral anticoagulation therapy. At present, several devices have been developed specifically for percutaneous occlusion of the left atrial appendage. Current results show good feasibility and efficacy for these devices, with a high rate of successful implantation, although also associated with the inherent potential periprocedural complications. This work reviews the current state of the art of percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation.
authors: Cardiovascular Intervention Unit, Cardiology Service, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. silvionleal@gmail.com
authors: Silvio
authors: S
authors: Leal
authors: Raul
authors: R
authors: Moreno
authors: Manuel
authors: M
authors: de Sousa Almeida
authors: Jose Aniceto
authors: JA
authors: Silva
authors: Jose L
authors: JL
authors: Lopez-Sendon
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000075202:Contraindications; D006801:Humans; D011474:Prosthesis Design; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants