January 1, 2018Open Access
Left Atrial Appendages Occlusion: Current Status and Prospective
Resultado clave
Left atrial appendage occlusion provides a promising alternative to oral anticoagulation for stroke prophylaxis in patients with nonvalvular atrial fibrillation.
PICO estructurado
Do left atrial appendage occlusion (LAAO) techniques provide effective and safe stroke prophylaxis compared to oral anticoagulation in patients with nonvalvular atrial fibrillation?
P
Población
Patients with nonvalvular atrial fibrillation (AF) who require stroke prophylaxis but have bleeding complications with oral anticoagulation
I
Intervención
Left atrial appendage occlusion (LAAO) techniques (including Watchman, Amulet, Amplatzer Cardiac Plug, and Lariat devices)
C
Comparador
Oral anticoagulation (OAC)
O
Resultado
Efficacy and safety of different LAAO devices for stroke prophylaxis
LAAO provides a promising alternative to oral anticoagulation for stroke prophylaxis in nonvalvular AF patients with bleeding risks, though device-related thrombosis remains a concern and more randomized data are needed for newer devices.
Limitaciones
- Data on Amplatzer Cardiac Plug, Amulet and Lariat devices are limited by the paucity of randomized data.
- Device related thrombosis continues to be a serious complication associated with LAAO.
- The only randomized controlled trials on LAAO available until now have excluded patients with contraindications to OAC therapy.
Resumen
Stroke continues to be a major cause of morbidity and mortality in atrial fibrillation (AF) patients. Oral anticoagulation (OAC) provides protection against stroke and peripheral embolization in AF but significant proportion of patients could not be started on anticoagulation because of bleeding complications. Left atrial appendage harbors clot in about 90% of nonvalvular AF. The advent of left atrial appendage occlusion (LAAO) techniques has provided these patients with alternative to OAC for stroke prophylaxis. Multiple LAAO devices are currently available with Watchman and Amulet being the most commonly used in clinical practice. Randomized studies are available for Watchman device only. Data on Amplatzer Cardiac Plug, Amulet and Lariat devices are limited by the paucity of randomized data. Long-term data on different LAAO techniques are showing promising results. Device related thrombosis continues to be a serious complication associated with LAAO. Future studies should look into comparative effectiveness between different LAAO techniques, optimal patient selection, risk of complications, and anticoagulant treatment after LAAO. This article aims to provide current available evidence on efficacy and safety of different LAAO devices and future prospective.