Modification of the left atrial appendage and its role in stroke risk reduction with non-valvular atrial fibrillation. (February 2021)

• Record Type: Journal Article
• Authors: Rashid, Hashrul N.; Layland, Jamie
• Is Part Of: IJC heart & vasculature. Volume 32(2021)
• Publication Date: 2021-02
• Subjects: Atrial fibrillation -- Left atrial appendage occlusion -- Left atrial appendage occluder -- Watchman device -- Thrombosis -- Stroke; ACC American College of Cardiology -- AF Atrial fibrillation -- AHA American Heart Association -- DRT Device related thrombus -- ESC European Society of Cardiology -- FDA Food and Drug Administation -- HR Hazard ratio -- LAA Left atrial appendage -- LAAE Left atrial appendage exclusion -- LGE Late gadolinium enhancement -- OAC Oral anticoagulation -- OR Odds ratio -- TOE Trans-oesopheageal echocardiogram; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2020.100688
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Evidence on surgical LAA excision has been limited to retrospective studies and registries. Surgical LAA excision is associated with high rates of post-operative atrial fibrillation burden. Watchman is equivalent to oral anticoagulants in high-bleeding risk AF patients. Abstract: Atrial fibrillation is one of the most common cardiovascular disorders encountered by clinicians in clinical practice. Patients with atrial fibrillation are at risk of cerebrovascular and systemic embolic events, which may be attenuated by commencement of anticoagulation therapy. Even so, due to extremely high bleeding risk certain patients may not be suitable for long-term anticoagulation therapy. The left atrial appendage is a common site for thrombus formation in patients with atrial fibrillation. Left atrial appendage exclusion, either surgical or percutaneous, has been performed to ostensibly reduce the risk of cerebrovascular events and potentially minimise or omit anticoagulation therapy in select patients. This review summarises the role of the left atrial appendage in cerebrovascular events, current evidence with modification of the left atrial appendage and future trials that may change practice with these procedures.