Evidence and Challenges in Left Atrial Appendage Management

Area of Science:

• Cardiology
• Medical Devices
• Anatomy

Background:

• Atrial fibrillation (AF) management often involves anticoagulation, which presents challenges for many patients.
• The left atrial appendage (LAA) plays a significant role in AF pathophysiology and stroke risk.
• Understanding LAA anatomy and physiology is essential for effective treatment strategies.

Purpose of the Study:

• To review the anatomical properties of the left atrial appendage (LAA).
• To discuss the relationship between LAA and atrial fibrillation (AF).
• To evaluate the effectiveness, techniques, and devices for LAA occlusion (LAAO).

Main Methods:

• An electronic literature search was conducted on PubMed Central, Scopus, and Medline.
• Studies were identified in the English language from database inception to February 2020.
• Data extraction was performed by two independent authors from reviewed papers.

Main Results:

• Anticoagulant therapy is recommended for AF but challenging for some patients.
• Surgical and catheter-based LAA occlusion (LAAO) are effective alternatives.
• Various LAAO techniques and devices exist, each with pros and cons.

Conclusions:

• Managing the LAA requires understanding its anatomical and physiological changes during AF, including remodeling, nerve function, and thrombosis.
• Early intervention for the LAA should be considered, especially in recurrent AF.
• LAA occlusion offers a viable treatment option for select AF patients.