Role of Endovascular Closure of the Left Atrial Appendage in Stroke Prevention for Atrial Fibrillation

Jawad Kiani, David Holmes

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

The pathophysiologic mechanism of thromboembolic stroke in the setting of non-valvular atrial fibrillation (AF) resides in the left atrial appendage (LAA). In this setting, approximately 90 % of all strokes originate from this structure. Percutaneous left atrial appendage occlusion (LAAO) therapy has recently emerged as an important strategy for prevention of stroke and systemic embolism in patients with non-valvular AF. Systemic anticoagulation therapy in this AF population, while effective, is associated with a significant bleeding risk, drug compliance issues, and limited reversal strategies. In this manuscript, we will review the percutaneous devices and techniques that allow endovascular closure of the LAA, including their efficacy in stroke prevention, the safety profile of these local site-specific therapies, comparison of the multiple approaches being studied, the index patient populations involved, and long-term follow-up in comparison with systemic anticoagulation therapy. The percutaneous LAAO approach indeed represents an exciting and revolutionary advance in the field of stroke prevention in AF.

Original languageEnglish (US)
Article number65
JournalCurrent atherosclerosis reports
Volume17
Issue number11
DOIs
StatePublished - Nov 30 2015

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Keywords

  • Amplatzer Cardiac Plug
  • Anticoagulation
  • ASAP
  • Atrial fibrillation
  • Efficacy
  • Embolization
  • LARIAT
  • Operator learning curve
  • Percutaneous left atrial appendage occlusion
  • Perforation
  • Pericardial effusion
  • Pericardiocentesis
  • PREVAIL
  • PROTECT AF
  • Residual leaks
  • Safety
  • Stroke
  • Systemic embolism
  • Transcatheter
  • WATCHMAN
  • WaveCrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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