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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Modification of the left atrial appendage and its role in stroke risk reduction with non-valvular atrial fibrillation

Hashrul N Rashid1,2, Jamie Layland2,3

  • 1Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.

International Journal of Cardiology. Heart & Vasculature
|December 23, 2020
PubMed

Insights

Atrial fibrillation patients at risk of stroke can benefit from left atrial appendage exclusion. This procedure may reduce embolic events and potentially allow omission of anticoagulation therapy in select individuals.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Neurology

Background:

  • Atrial fibrillation is a prevalent cardiovascular disorder.
  • Patients face risks of cerebrovascular and systemic embolic events.
  • Anticoagulation therapy is standard but carries bleeding risks for some.

Purpose of the Study:

  • To review the role of the left atrial appendage in embolic events.
  • To summarize current evidence on left atrial appendage modification.
  • To discuss future trials impacting procedural practices.

Main Methods:

  • Literature review of atrial fibrillation, embolic events, and left atrial appendage.
  • Analysis of current evidence on surgical and percutaneous left atrial appendage exclusion.
  • Examination of ongoing and planned clinical trials.

Main Results:

  • The left atrial appendage is a primary site for thrombus formation in atrial fibrillation.
  • Left atrial appendage exclusion aims to reduce embolic risk.
  • Procedures may enable anticoagulation minimization or omission.

Conclusions:

  • Left atrial appendage exclusion is a strategy for stroke risk reduction in atrial fibrillation.
  • Further evidence from trials will refine patient selection and procedural indications.
  • This approach offers an alternative for patients unsuitable for long-term anticoagulation.

Keywords:
ACC, American College of CardiologyAF, Atrial fibrillationAHA, American Heart AssociationAtrial fibrillationDRT, Device related thrombusESC, European Society of CardiologyFDA, Food and Drug AdministationHR, Hazard ratioLAA, Left atrial appendageLAAE, Left atrial appendage exclusionLGE, Late gadolinium enhancementLeft atrial appendage occluderLeft atrial appendage occlusionOAC, Oral anticoagulationOR, Odds ratioStrokeTOE, Trans-oesopheageal echocardiogramThrombosisWatchman device

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