Minimally Invasive Closure of the Left Atrial Appendage: A Non-Pharmacologic Approach to Prevention of Stroke in Patients with Atrial Fibrillation

Abstract

Atrial Fibrillation's (AF) role in the pathogenesis of thromboembolic stroke has been well established, with estimates from trials of approximately 15-20% of all strokes in the U.S. Research shows more than 90% of atrial thrombi originate from the left atrial appendage (LAA). Traditionally, oral anticoagulants (OACs) have been the keystone of management for AF in reducing the risk of thromboembolic stroke. However, OACs also pose a non-negligible risk of bleeding with between 30-50% of eligible patients not receiving OACs due to absolute contraindications or perceived increased bleeding risk. New technologies aimed at isolating the LAA through ligation, exclusion, or occlusion are attempting to mitigate the embolic risk posed by LAA thrombi while simultaneously reducing the bleeding risk associated with OAC. In this review, we discuss the safety, efficacy, and clinical utility of these technologies as alternatives to OACs. [Full article available at http://rimed.org/rimedicaljournal-2017-05.asp].

Keywords: Atrial fibrillation; Lariat; Left atrial appendage closure; Watchman; stroke.