Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal

Abstract

The authors review the current status of percutaneous left atrial appendage (LAA) occlusion therapy in patients with atrial fibrillation with the goal to prevent ischemic stroke and systemic embolism and to reduce oral anticoagulation associated bleeding. While we cover the historical and also surgical background, and all tested devices, the main focus rests on the single currently U.S. Food and Drug Administration (FDA) approved LAA occluder, the WATCHMAN device, and its approval process. The authors also give a critical appraisal beyond the review of mere facts, trying to put the current data into perspective.

Keywords: Atrial appendage occlusion; Atrial fibrillation; Brain ischemia; Intracranial hemorrhage; Stroke.

Figure 1.

Left atrial appendage (LAA) closure devices and schematics of their deployment. Different types of LAA closure devices are seen. Endocardial devices include (A) WATCHMAN™ (image provided courtesy of Boston Scientific, c2018 Boston Scientific Corporation or its affiliates, http://www.bostonscientific.com) and (B) AMPLATZER™ AMULET™ (reproduced with permission of St. Jude Medical, c2018, https://www.sjmglobal.com). (C) The hybrid (endocardial and epicardial) LARIAT™ suture delivery system for LAA exclusion (reproduced with permission of SENTREHEART, c2018, http://www.sentreheart.com) and (D) AtriClip™ for surgical clipping (reproduced with permission of AtriCure, c2018, https://www.atricure.com). Devices are trademarks of their respective companies, all rights reserved. Adapted from Topcuoglu et al[22]