Cor Vasa 2016, 58(2):e250-e260 | DOI: 10.1016/j.crvasa.2016.02.007

Percutaneous closure of left atrial appendage for stroke prevention

Petr Neužil^a,b,*, Tomáš Mráz^a,b, Jan Petrů^a,b, Pavel Hála^a,b, Martin Mates^a,b, Petr Kmoníček^a,b, Milena Prokopová^a,b, Vivek Y. Reddy^a,b

^a Kardiologické oddělení, Nemocnice Na Homolce, Praha, Česká republika

^b Mount Sinai Medical Center, New York, NY, USA

Transcatheter left atrial appendage closure (LAAC) is an alternative therapy for stroke prevention in atrial fibrillation (AF) patients. There are increasing data supporting this ''local'' prevention of thromboembolism in the patients with high-risk CHA2DS2-VASc score. LAAC might be a very important alternative in patients with limitations/contraindication to the anticoagulation therapy. Two main randomized clinical trials data indicated the utility and safety of WATCHMAN LAAC device for stroke prevention in patients with AF as a non-inferior treatment strategy. Despite overall effectiveness showed for all currently used mechanical occluders (prospective, multicentric studies), clear profit of these devices could be limited by: (a) residual tamponade rate of 1-3%; (b) lack of complete 100% closure in one third of patients. To improve the outcome, the new generations of these devices are designed to present: (i) a less traumatic implanting procedure; (ii) better placement and coverage of the LAA orifice. The present article summarizes the rationale, clinical data, devices, implantation techniques and follow-up drug regimens.
In conclusion, we need more data and more studies to prove the LAAC principle specifically in the new era of direct oral anticoagulation therapy.

Keywords: Atrial fibrillation; Left atrial appendage occlusion; Stroke; Thromboembolism

Received: December 5, 2015; Revised: February 17, 2016; Accepted: February 18, 2016; Published: April 1, 2016  Show citation