title: Left atrial appendage closure-indications, techniques, and outcomes: results of the European Heart Rhythm Association Survey.
abstract: The purpose of this EP Wire was to assess the indications, techniques, and outcomes of left atrial appendage occlusion (LAAO) in Europe. Thirty-three European centres, all members of the European Heart Rhythm Association electrophysiology (EP) research network, responded to this survey by completing the questionnaire. The major indication for LAAO (94%) was the prevention of stroke in patients at high thrombo-embolic risk (CHA2DS2-VASc ≥ 2) and contraindications to oral anticoagulants (OACs). Twenty-one (64%) of the responding centres perform LAAO in their own institution and 80% implanted 30 or less LAAO devices in 2014. Two-dimensional transoesophageal echocardiography was the preferred imaging technique to visualize LAA before, during, and after LAAO in 79, 58, and 62% of the participating centres, respectively. Following LAAO, 49% of the centres prescribe vitamin K antagonists or novel OACs. Twenty-five per cent of the centres combine LAAO with pulmonary vein isolation. The periprocedural complications included death (range, 0-3%), ischaemic or haemorrhagic stroke (0-25%), tamponade (0-25%), and device embolization (0-20%). In conclusion, this EP Wire has demonstrated that LAAO is most commonly employed in patients at high thrombo-embolic risk in whom OAC is contraindicated. The technique is not yet very widespread and the complication rates remain significant.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, PO Box 5800, Maastricht 6229 HX, The Netherlands l.pison@mumc.nl.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
authors.affiliation: School of Medicine, University of Belgrade, Serbia and Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Tatjana S
authors.initials: TS
authors.lastname: Potpara
authors.affiliation: Department of Heart Disease, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark.
authors.forename: Torben B
authors.initials: TB
authors.lastname: Larsen
authors.affiliation: CardioThoracic and Vascular Department, University Hospital, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Carina
authors.initials: C
authors.lastname: Blomström-Lundqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery; D015984:Causality; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; EHRA survey; EP wire; Left atrial appendage; Occluder; Outcome; Stroke