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Published on: February 26, 2013
Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation
Fareed Moses S Collado1, Claudia M Lama von Buchwald1, Christina K Anderson1
1Rush University Medical Center Chicago IL.
Insights
Effective stroke prevention in nonvalvular atrial fibrillation (AF) is crucial. Left atrial appendage occlusion offers a non-drug alternative to anticoagulation, addressing bleeding risks and adherence issues in AF patients.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Embolic strokes in nonvalvular atrial fibrillation (AF) often originate from the left atrial appendage (LAA).
- Projected increases in AF-related strokes necessitate effective mitigation strategies.
- Systemic anticoagulation is effective but limited by bleeding risks and patient adherence.
Purpose of the Study:
- To provide a contemporary review of left atrial appendage occlusion (LAAO) for stroke prevention in nonvalvular AF.
- To discuss the evolution and current status of LAAO devices.
Main Methods:
- Review of historical and recent clinical trials on LAAO devices.
- Examination of US Food and Drug Administration (FDA) milestones for LAAO devices.
- Analysis of both surgical and percutaneous LAAO strategies.
Main Results:
- LAAO devices represent a significant non-pharmacologic approach to stroke risk reduction in AF.
- Both surgical and percutaneous LAAO have demonstrated efficacy in preventing embolic events.
- Current LAAO devices have achieved important regulatory milestones.
Conclusions:
- LAAO is a viable alternative to anticoagulation for stroke prevention in select nonvalvular AF patients.
- Ongoing research and device development continue to refine LAAO therapies.
- LAAO addresses key limitations of anticoagulation, improving stroke risk management in AF.
Abstract:
The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke prevention in nonvalvular atrial fibrillation. A thorough review of the history of surgical and percutaneous left atrial appendage occlusion devices, recent trials, and US Food and Drug Administration milestones of current left atrial appendage occlusion devices are discussed.
