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Atrial Fibrillation in Heart Failure: Left Atrial Appendage Management

Christopher R Ellis1, Arvindh N Kanagasundram2

  • 1Left Atrial Appendage Program, Vanderbilt University Medical Center, 5414 Medical Center East, 1211 21st Avenue South, Nashville, TN 37232-8802, USA.

Cardiology Clinics
|March 31, 2019
PubMed

Insights

Congestive heart failure (CHF) patients with atrial fibrillation face high stroke risks. Device-based left atrial appendage closure (LAAC) may offer benefits but requires further study due to increased thrombus risks.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Biomedical Engineering

Background:

  • Atrial fibrillation (AF) is prevalent in congestive heart failure (CHF) patients.
  • CHF patients exhibit reduced left atrial appendage (LAA) emptying and increased sludge, elevating stroke and embolism risks.
  • Anticoagulation inadequately protects up to 50% of CHF patients, who remain at risk for LAA or left ventricular (LV) thrombus.

Purpose of the Study:

  • To evaluate the efficacy and safety of device-based left atrial appendage closure (LAAC) in CHF patients with AF.
  • To investigate the incidence of device-related thrombus following LAAC in this patient population.
  • To identify strategies for optimizing LAAC benefits in CHF patients.

Main Methods:

  • Review of clinical data for CHF patients undergoing LAAC.
  • Analysis of stroke, embolism, and thrombus formation rates post-LAAC.
  • Comparison of outcomes between LAAC and anticoagulation therapy.

Main Results:

  • CHF patients experience elevated stroke and embolism risks due to LAA dysfunction.
  • A significant rate of device-related thrombus is observed after LAAC in heart failure patients.
  • Inadequate stroke protection persists in a substantial portion of CHF patients on anticoagulation.

Conclusions:

  • Device-based LAAC presents an alternative for stroke prevention in CHF patients with AF.
  • Further research is crucial to mitigate the increased risk of device-related thrombus post-LAAC in heart failure.
  • Optimizing LAAC strategies is essential to maximize its therapeutic benefits for this high-risk group.

Keywords:
Atrial fibrillationIntracardiac thrombusLAALeft atrial appendage

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