Left atrial appendage occlusion: Contemporary review and current challenges

Abstract

Atrial fibrillation-related stroke is associated with significant morbidity. Historically, oral anticoagulation has been the mainstay of risk reduction of thromboembolic events in atrial fibrillation. Oral anticoagulation for stroke prevention, while effective, has its challenges with increased bleeding risks. Percutaneous closure of the left atrial appendage (LAA) has emerged as a studied, proven, and Food and Drug Administration-approved alternative treatment for atrial fibrillation-related stroke prevention. Nuances to device technology and design have made LAA occlusion (LAAC) a promising area of thromboembolic protection for patients with atrial fibrillation. Cardiovascular imaging is the backbone of LAAC, and imaging techniques have been refined in recent years to supplement procedure planning, reduce invasiveness, minimize complications, and, in general, optimize procedural success. In this review, we assess the role of LAAC and its efficacy. We also review the indications for LAAC and, in doing so, identify key patient populations that benefit from this procedure. In addition, we evaluate imaging modalities that are currently used for the procedure and discuss the current challenges related to these percutaneous devices in reducing the embolic risk. As there are several devices on the market for LAAC, we also review the devices available for implantation. Our hope in offering this review of LAA closure literature is to increase awareness of this procedure, highlight its benefits and safety profile, and emphasize the further need for more data on the use of these devices in key patient populations.

Keywords

Left atrial appendage / Atrial fibrillation / Thromboembolism / Anticoagulation / Cardiovascular imaging

Acknowledgments

None.

Funding

None.

Conflict of interest

Chunguang Chen is the Guest Editor of this special issue, but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Author contributions

Conceptualization: Chunguang Chen, Daniel S. Ice

Writing - original draft: Mihir V. Odak, Chamaka Kalutota, Steven Douedi, Zachary Estep, Andrew Josephson, Gin Chang

Writing - review & editing: Mihir V. Odak, Chamaka Kalutota

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Not applicable.

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