Key result
Transcatheter left atrial appendage occlusion serves as an alternative to oral anticoagulation for patients with atrial fibrillation and contraindications to anticoagulant therapy.
Why the study?
Left atrial appendage occlusion is increasingly used as an alternative to oral anticoagulation in atrial fibrillation patients with contraindications, warranting a review of patient selection, available devices, and procedural imaging.
This state-of-the-art review provides a comprehensive overview of patient selection, contemporary devices, and the role of multimodality imaging in transcatheter left atrial appendage occlusion.
Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants. Some other potential indications are also described. In the second part of the manuscript, we review available devices, trying to highlight different aspects and potential specific advantages. The last section overviews different ways for pre-, intra- and postprocedural imaging, in order to improve procedural safety and efficacy and ameliorate patient outcome. The characteristics of available contemporary devices and the role of imaging in procedural planning, intraprocedural guidance and follow-up are described.
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Pastormerlo et al. (2024) conducted a review in Atrial fibrillation. Left atrial appendage occlusion (LAAO) vs. Oral anticoagulation was evaluated. Transcatheter left atrial appendage occlusion serves as an alternative to oral anticoagulation for patients with atrial fibrillation and contraindications to anticoagulant therapy.
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