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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Peri- and Post-procedural Anticoagulation with Left Atrial Appendage Occlusion Devices

Pradyumna Agasthi1, Sai Harika Pujari2

  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

Heart International
|July 17, 2023
PubMed

Insights

Left atrial appendage occlusion is an alternative stroke prevention strategy for patients with atrial fibrillation and high bleeding risk. This review covers procedural anticoagulation, complications, and device-related thrombosis risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Atrial fibrillation increases stroke risk due to left atrial appendage thrombus formation.
  • Anticoagulation is standard for stroke prevention but carries bleeding risks.
  • Percutaneous left atrial appendage occlusion (LAAO) offers an alternative for high-risk patients.

Purpose of the Study:

  • To review peri- and post-procedural anticoagulation/antithrombotic therapy after LAAO.
  • To discuss complications, device-related thrombosis, and incomplete occlusion risks.
  • To identify literature limitations and gaps in LAAO management.

Main Methods:

  • Literature review of current studies on LAAO.
  • Analysis of anticoagulation protocols and outcomes.
  • Examination of procedural complication rates and thrombosis risks.

Main Results:

  • Standardized peri- and post-procedural antithrombotic strategies are crucial for LAAO success.
  • Device-related thrombosis and incomplete occlusion are significant risks requiring monitoring.
  • Optimal antithrombotic regimens post-LAAO are still under investigation.

Conclusions:

  • LAAO is a viable stroke prevention option for select atrial fibrillation patients.
  • Careful management of antithrombotic therapy and monitoring for complications are essential.
  • Further research is needed to optimize LAAO protocols and long-term outcomes.

Keywords:
Anticoagulationantithrombotic therapyatrial fibrillationbleeding riskdirect oral anticoagulantsleft atrial appendage occlusionstrokevitamin K antagonists

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