title: Stroke prevention in atrial fibrillation with left atrial appendage closure.
abstract: Patients with atrial fibrillation (AF) are at risk for stroke and thromboembolism. Oral anticoagulants (OAC) are effective therapies to reduce the risk of stroke; however, these agents also increase the risk of bleeding complications. Concerns over bleeding contribute to significant under treatment and leave a substantial proportion of patients at risk for a serious or life-threatening stroke. Identification of the left atrial appendage (LAA) as the major site of pathogenic thrombus formation in AF patients has led to the development of devices which exclude the appendage from the systemic circulation. These devices offer a potential alternative treatment for some AF patients who cannot tolerate long term OAC. This article will review the pathogenesis of LAA thrombus formation and identify the patient population most likely to benefit from LAA closure devices. Finally, we will review LAA closure techniques (both surgical and percutaneous), evaluate published outcomes data, and discuss the indications and risk/benefit considerations of each approach.
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Zack
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Fender
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA - holmes.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications*; D004867:Equipment Design; D006801:Humans; D017410:Practice Guidelines as Topic; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*; D065506:Vascular Closure Devices
chemical_list: D000925:Anticoagulants