title: Left atrial appendage exclusion for prevention of stroke in atrial fibrillation: review of minimally invasive approaches.
abstract: Stroke prevention is of vital importance in the management of atrial fibrillation (AF), though the proven strategy of systemic anticoagulation for thromboembolic prophylaxis is underutilized for a variety of reasons. The left atrial appendage (LAA) has long been suspected as the principal source of arterial emboli, particularly in nonvalvular AF, and a variety of techniques for its exclusion from the circulation have been developed. This review highlights the history of the LAA as a target of intervention, and the parallel advances in three minimally invasive strategies for its exclusion: percutaneous occlusion of the LAA orifice from within the left atrium, closed-chest ligation via a percutaneous pericardial approach, and minimally invasive thoracoscopic surgery. While further study is necessary, available evidence suggests that effective LAA exclusion is becoming a viable alternative to anticoagulation for stroke prevention in nonvalvular AF.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Chicago, 5758 S. Maryland Ave, MC 9024, Chicago, IL, 60637, USA, jmoss@medicine.bsd.uchicago.edu.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Moss
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000517:prevention & control; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*