title: [GISE/AIAC position paper on percutaneous left atrial appendage occlusion in patients with nonvalvular atrial fibrillation: recommendations for patient selection, facilities, competences, organizing and training requirements].
abstract: Thromboembolism from the left atrial appendage is the most feared complication in patients with atrial fibrillation (AF). The cornerstone for the management of chronic nonvalvular AF is stroke reduction with oral anticoagulation (OAC). However, poor compliance, maintaining a narrow therapeutic window, and major side effects such as bleeding have severely limited its use, creating a therapeutic dilemma. About 20% of AF patients do not receive OAC due to contraindications and less than half of AF patients are not on OAC due to reluctance of the prescribing physician and/or patient non-compliance. Fortunately, over the past decade, the introduction of percutaneous approaches for left atrial appendage occlusion has offered a viable alternative to the management of nonvalvular AF in patients with OAC contraindication. Occlusion devices such as the Amplatzer Cardiac Plug and Watch man device have shown their noninferiority to OAC for stroke prophylaxis with less bleeding complications, while more recently some new devices have been introduced. The aim of this position paper is to review the most relevant clinical aspects of left atrial appendage occlusion from patient selection to periprocedural and follow-up management. In addition, the importance of a medical team and an organizational environment adequate to optimize all the steps of this procedure is discussed.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.forename: Roberto
authors.initials: R
authors.lastname: De Ponti
authors.forename: Paolo
authors.initials: P
authors.lastname: Danna
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D002983:Clinical Competence; D006801:Humans; D007558:Italy; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D055989:Septal Occluder Device; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants