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Current State of Left Atrial Appendage Closure

  • Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)
  • Published:
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Abstract

Purpose of Review

Atrial fibrillation (AF), the most common sustained arrhythmia, is a major cause of stroke and systemic embolism, and is increasing in prevalence. Device closure of the left atrial appendage (LAA) represents a non-pharmacologic approach to stroke prevention in AF patients. This review presents the rationale for LAA closure (LAAC), describes current transcatheter approaches to LAAC, and summarizes the current evidence for LAAC for stroke prevention, highlighting the main randomized trials and the most recent data available.

Recent Findings

Meta-analysis of randomized clinical trials demonstrates similar rates of all-cause stroke with transcatheter LAAC compared with vitamin K antagonist therapy and significantly less bleeding with LAAC after cessation of mandated post-procedure pharmacology. Recent prospective observational studies, including those evaluating outcomes after commercial approval in the USA, show significantly improved procedure safety compared with earlier experiences.

Summary

LAAC appears to be an attractive alternative strategy for stroke prevention in AF patients, particularly in those who can take short-term oral anticoagulation (OAC), but are not optimal candidates for long-term OAC. Recent data suggests the procedure can be safely performed in patients with contraindications to OAC. Further, robust studies are needed to evaluate safety and efficacy in OAC-contraindicated patients, to compare outcomes with non-vitamin K antagonist OACs, and to explore the relative safety and efficacy of different LAAC devices.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, AMP-200, La Jolla, CA, 92037, USA

    Ricardo Kosturakis & Matthew J. Price

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  1. Ricardo Kosturakis
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Correspondence to Matthew J. Price.

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Conflict of Interest

Matthew J. Price has received consulting honoraria from Abbott Vascular, Boston Scientific, W.L. Gore, Medtronic, and AstraZeneca; has received speaker honoraria from Abbott Vascular, Medtronic, Terumo, and AstraZeneca; has received research grants from Daiichi Sankyo; has served as a site investigator for trials involving the Watchman device; has received honoraria as a proctor for Abbott Vascular and Boston Scientific; and is a member of the Steering Committee for the NCDR LAAO registry.

Ricardo Kosturakis has nothing to disclose.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Structural Heart Disease

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Kosturakis, R., Price, M.J. Current State of Left Atrial Appendage Closure. Curr Cardiol Rep 20, 42 (2018). https://doi.org/10.1007/s11886-018-0981-z

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