title: Mechanical antithrombotic intervention by LAA occlusion in atrial fibrillation.
abstract: Stroke in patients with atrial fibrillation (AF) is often associated with substantial morbidity and mortality. Oral anticoagulation remains the first-line approach to stroke prevention in such individuals; however, for a considerable proportion of patients, traditional treatment using warfarin is limited by a number of factors, such as the inconvenience of frequent therapeutic monitoring and the risk of haemorrhage. The development of new oral anticoagulants with improved efficacy and safety profiles has provided viable options for oral anticoagulation therapy in patients with nonvalvular (nonrheumatic AF). Nonetheless, in patients who have an increased risk of major haemorrhage, a nonpharmacological approach to antithrombotic therapy remains an attractive alternative. The left atrial appendage (LAA) has been found to be the source of >90% of thrombi in patients with nonvalvular AF; thus, prevention of thrombus formation via transcatheter mechanical LAA occlusion is a novel therapeutic target for stroke prevention in this patient population. In this Review, we present the rationale for LAA occlusion in patients with AF, the available occlusion devices and their clinical evidence to date. We also discuss the roles of various imaging techniques in device implantation and the management strategy for associated procedural complications.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Bertog
authors.forename: Alex P W
authors.initials: AP
authors.lastname: Lee
authors.forename: Joey S W
authors.initials: JS
authors.lastname: Kwong
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000818:Animals; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D003952:Diagnostic Imaging / Q000379:methods; D004867:Equipment Design; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D020521:Stroke / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D013927:Thrombosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome