Left atrial appendage occlusion in atrial fibrillation for stroke prevention: A systemic review.
BACKGROUND
Atrial fibrillation (AF) is an arrthymia characterized by increased risk of ventricle arrthymias and thromboembolism especially ischemic stroke. Most thrombus originated in the left atrial appendage, thus left atrial occlusion (LAAO) may be an effective alternative for stroke prevention in atrial fibrillation.


OBJECTIVE
To assess the effect and safety of left atrial occlusion for stroke prevention in atrial fibrillation.


RESULTS
We searched Pub Med, CENTRAL in The Cochrane Library, Embase, CBM-Disk, CNKI for published trials, ClinicalTrials.gov, ISI Proceedings for conference abstracts, and WHO International Clinical Trial registration Platform for ongoing studies. The search results were extracted, and then the quality of included studies was assessed. By RevMan 5.3, meta analysis was used if there was low heterogeneity. Three randomized controlled clinical trials involving 1165 participants were included (percutaneous 1114 in 2 trials, surgical 51 in 1 trial). The current data suggest that left atrial occlusion may be as efficacious as warfarin in stroke prevention (RR 0.78 [0.33, 1.84]) and mortality reduction (RR 0.68 [0.40, 1.16]) for AF.


CONCLUSIONS
In contrast to warfarin left atrial occlusion with Watchman device may have the same effectivity in stroke reduction. Surgical LAAO may also get positive outcomes compared with warfarin, but owing to the small sample size the evidence is less powerful. Total outcomes of percutaneous and surgical LAAO support this approach.
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Xianhui
X
Zhou
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Wenhui
W
Zhang
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Wenkui
W
Lv
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Qina
Q
Zhou
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Yaodong
Y
Li
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Ling
L
Zhang
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Yanmei
Y
Lu
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Jianghua
J
Zhang
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Qiang
Q
Xing
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Hongli
H
Wang
Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China. Electronic address: tangbaopeng@hotmail.com.
Baopeng
B
Tang
D006801:Humans; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
Atrial fibrillation; Left atrial appendage occlusion; Stroke