Percutaneous left atrial appendage occlusion is a technically feasible alternative for stroke prevention in selected atrial fibrillation patients, with successful implantation achieved in 97% of cases.
Does percutaneous left atrial appendage occlusion prevent ischaemic stroke in selected patients with atrial fibrillation?
Percutaneous LAA occlusion is a technically feasible and effective alternative for stroke prevention in selected AF patients, particularly those with contraindications to oral anticoagulation.
Oral anticoagulation (OAC) remains the mainstream therapy for ischaemic stroke prevention in patients with atrial fibrillation (AF). However, for patients contraindicated to OAC and those who experienced a stroke while on therapeutic OAC, no reasonable pharmacotherapy is available. Although surgical left atrial appendage (LAA) excision offers a non-pharmacological alternative, effective stroke prevention by this treatment is not demonstrated by randomized clinical studies. Percutaneous occlusion of the LAA may be an alternative therapy for selected AF patients. Recently reported results confirm the technical feasibility of this technique and its effectiveness in preventing ischaemic stroke. With increasing operator experience, successful and event-free device implantation is achieved in typically 97% of the cases. Moreover, in non-randomized cohorts implanted with LAA occlusion devices, stroke rates are markedly reduced compared with rates predicted by risk stratification schemes such as CHADS2 and CHA2DS2-VASc. This paper summarizes recently published results from clinical studies on percutaneous LAA occlusion and current expert opinions with respect to patients who may be suitable for this therapy. In addition, several aspects regarding the safety of device implantation for LAA occlusion and follow-up of patients are discussed.
Lewalter et al. (2013) conducted a review in Atrial fibrillation. Percutaneous left atrial appendage occlusion was evaluated. Percutaneous left atrial appendage occlusion is a technically feasible alternative for stroke prevention in selected atrial fibrillation patients, with successful implantation achieved in 97% of cases.