LEFT ATRIAL APPENDAGE CLOSURE


Stefan C. Bertog, M.D., CardioVascular Center, Frankfurt, Germany

Atrial fibrillation is a frequent cause of stroke. The mechanism in non-valvular atrial fibrillation is thrombus formation in the left atrium. Ninety percent of left atrial thrombi occur in the left atrial appendage. Anticoagulation with vitamin K antagonists has been demonstrated to substantially reduce the stroke risk in patients with atrial fibrillation (up to 60%). However, it is accompanied by significant logistical challenges related to required frequent laboratory monitoring, drug-drug and diet-drug interactions. More importantly, it is associated with a bleeding risk including intracranial hemorrhage. Therefore, it is not surprising that a large number of patients at risk for stroke are not treated with anticoagulation. Though new anticoagulants, particularly direct thrombin antagonists and Factor Xa inhibitors have a wider therapeutic range and do not require routine monitoring, they are also associated with significant bleeding risk. Moreover, those patients who have the highest stroke risk are also at greatest risk for bleeding. Hence, alternative methods to reduce the stroke risk in patients with atrial fibrillation are needed. Most recently, percutaneous left atrial appendage occlusion either via endocardial or combined endo- and epicardial approach has explored with one randomized trial demonstrating non-inferiority to anticoagulation with warfarin. The aim of this presentation is to review the role of percutaneous left atrial appendage closure for the prevention of strokes in the setting of atrial fibrillation.