Cardiovascular Therapies Targeting Left Atrial Appendage

Q: What is the clinical evidence from this study?

Study design: Review. Population: Atrial fibrillation. Intervention: Left atrial appendage (LAA) closure.

Q: What does this research mean for the field?

Left atrial appendage closure is a safe and effective strategy for stroke prevention in atrial fibrillation, though critical challenges remain regarding patient selection, device choice, and complication management. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohit K. Turagam; Poonam Velagapudi; Saibal Kar; David R. Holmes; Vivek Yerrapu Reddy; Marwan M. Refaat; Luigi Di Biase; Amin Al‐Ahmed; Mina K. Chung; Thorsten Lewalter; James R. Edgerton; James L. Cox; John D. Fisher; Andrea Natale; Dhanunjaya Lakkireddy

doi:10.1016/j.jacc.2018.05.048

June 26, 2018Journal of the American College of CardiologyOpen Access

Cardiovascular Therapies Targeting Left Atrial Appendage

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Key result

Left atrial appendage closure is an effective stroke prevention strategy in atrial fibrillation, though unresolved issues remain regarding optimal patient selection and complication management.

Why the study?

There are unresolved issues regarding optimal patient and device selection and management of complications in left atrial appendage closure for stroke prevention in atrial fibrillation.

Does left atrial appendage (LAA) closure safely and effectively prevent stroke in patients with atrial fibrillation?

Key Points

To review the rationale, clinical evidence, patient selection criteria, and procedural challenges associated with mechanical left atrial appendage exclusion.
Synthesized safety and efficacy evidence from randomized clinical trials evaluating percutaneous closure devices.
Assessed observational data from large clinical registries and reports evaluating epicardial closure interventions.
Percutaneous left atrial appendage closure provides safe and effective stroke prevention in patients suitable for oral anticoagulation.
Epicardial left atrial appendage exclusion demonstrates reductions in arrhythmia burden and improvements in systemic homeostasis via neurohormonal modulation.
Key clinical challenges persist regarding optimal candidate selection, device selection, device-related thrombus, residual leaks, and pericarditis.

Structured PICO

Does left atrial appendage (LAA) closure safely and effectively prevent stroke in patients with atrial fibrillation?

P

Population

Patients with atrial fibrillation who are considered suitable for oral anticoagulation

I

Intervention

Left atrial appendage (LAA) closure

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Implication

Left atrial appendage closure is an effective strategy for stroke prevention in AF, though challenges remain regarding patient and device selection, as well as management of periprocedural complications.

Abstract

Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.

Discussion

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Cite This Study

Turagam et al. (2018) conducted a review in Atrial fibrillation. Left atrial appendage (LAA) closure was evaluated. Left atrial appendage closure is an effective stroke prevention strategy in atrial fibrillation, though unresolved issues remain regarding optimal patient selection and complication management.

synapsesocial.com/papers/6acf1539e9cf455829e37413 https://doi.org/10.1016/j.jacc.2018.05.048

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Cardiovascular Therapies Targeting Left Atrial Appendage

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiovascular Therapies Targeting Left Atrial Appendage

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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