Who Should Be Referred for Left Atrial Appendage Occlusion Therapy?

Sidakpal S. Panaich, David Holmes

Research output: Contribution to journalReview article

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 7 million individuals in USA. It is one of the most significant arrhythmias, which accounts for a majority of embolic strokes, especially in elderly individuals. Although oral anti-coagulation is beneficial in lowering the risk of stroke, 1 in 10 patients have a contra-indication to warfarin therapy. Among patients who do tolerate either warfarin or novel oral anticoagulant (NOAC), major or recurrent bleeding, intracranial bleeds, etc. often lead to interruption of anti-coagulation. Previous studies have reported that >90% of cardioemboli in non-valvular atrial fibrillation (NVAF) originate in the left atrial appendage. Left atrial appendage occlusion (LAAO) is currently covered by the Centers for Medicare & Medicaid Services (CMS) as an alternative for stroke prevention in patients with an elevated stroke risk (CHADS2 ≥2 or CHA2DS2-VASc score ≥3) who have appropriate rational for avoiding long-term oral anticoagulation following a shared-decision making process. In this review, we discuss the currently available LAAO devices and more importantly, appropriate patient selection for this strategy.

Original languageEnglish (US)
Article number42
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume19
Issue number6
DOIs
StatePublished - Jun 1 2017

Keywords

  • Atrial fibrillation
  • Left atrial appendage occlusion
  • Watchman

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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