title: Percutaneous occlusion of the left atrial appendage: An expert consensus statement.
abstract: Atrial fibrillation (AF) is the most common rhythm disturbance. Among the major thromboembolic complications associated with AF, strokes are foremost, with a 4.4% yearly incidence in the absence of preventive treatment. Therefore, the prevention of these embolic accidents is a priority. While proof of the efficacy of oral anticoagulants (OACs) for this indication is long-standing and convincing, they are associated with haemorrhagic complications. Consequently, their prescription is based on an estimate of the risk (haemorrhagic complications)/benefit (thromboembolic prevention) ratio. In a patient subset at high thromboembolic and haemorrhagic risk, whether to prescribe or abstain from prescribing an OAC is a challenging decision, and an alternative means of thromboembolic prevention is desirable. Percutaneous occlusion of the left atrial appendage (LAA) is an alternative, interventional, non-pharmacological treatment that has been used widely in Europe and for a few years in France, with encouraging results. However, it remains an invasive procedure with a low level of proof in comparison with OACs. Moreover, the indications, the procedural environment and pre-per-post procedural patient management are major questions about this technique, with consequences on its efficacy and risk/benefit ratio. This document, composed by consensus among experts in the field, is an in-depth review of this new therapy.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.forename: Philippe
authors.initials: P
authors.lastname: Commeau
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquie
authors.forename: Patrice
authors.initials: P
authors.lastname: Guerin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.forename: René
authors.initials: R
authors.lastname: Koning
authors.forename: Olivier
authors.initials: O
authors.lastname: Piot
mesh_terms: D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D002309:Cardiology / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D032921:Consensus; D006339:Heart Rate; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome