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Review
. 2023 Mar 15;9(1):70-77.
doi: 10.4244/AIJ-D-22-00040. eCollection 2023 Mar.

Percutaneous left atrial appendage closure: beyond the classic indications

Enio E Guérios  1 , Francisco Chamié  2
Affiliations
Review

Percutaneous left atrial appendage closure: beyond the classic indications

Enio E Guérios et al. AsiaIntervention. .

Abstract

Percutaneous left atrial appendage closure (LAAC) has proven to be an effective alternative to oral anticoagulation (OAC) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). International guidelines traditionally recommend LAAC for NVAF patients at high thromboembolic risk and contraindication to or at high risk for OAC. However, there are many other clinical situations in which this procedure may also be beneficial. This paper discusses the potential role of LAAC in specific haemorrhagic diseases (cerebral amyloid angiopathy, age-related macular degeneration, hereditary haemorrhagic telangiectasia, and Moyamoya disease), after left atrial appendage (LAA) electrical isolation, in cases of persistent thrombus inside the LAA, in end-stage renal disease and in special groups of patients for whom low compliance and persistence to OAC may be anticipated.

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Conflict of interest statement

E.E. Guérios received consulting fees/honoraria from Abbott Vascular, Lifetech Scientific, and Boston Scientific; and is proctor for left atrial appendage closure for Abbott and Lifetech Scientific. F. Chamié received consulting fees from Abbott Vascular and Lifetech Scientifc; honoraria from Lifetech Scientific; and is proctor for left atrial appendage closure for Abbott and Lifetech Scientific.

Figures

Central illustration
Central illustration. Left atrial appendage closure (LAAC); beyond the classic indications.
Classic (A) and potential additional indications (B) for LAAC. LAA: left atrial appendage
Figure 1
Figure 1. Cerebral amyloid angiopathy.
Axial T2-weighted brain magnetic resonance imaging showing multiple black spots corresponding to perivascular haemosiderin deposits, compatible with microbleeds. A) Diffuse microbleeds, typical of hypertensive microangiopathy; B) cortical/subcortical microbleeds (arrows), typical of cerebral amyloid angiopathy. Images courtesy of Dr. VF Zétola, MD, PhD.
Figure 2
Figure 2. Age-related macular degeneration.
Choroidal neovascularisation and subretinal haemorrhages (asterisks) associated with neovascular (wet) age-related macular degeneration, shown in (A) colour fundus photograph and (B) fluorescein angiogram.
Figure 3
Figure 3. Persistent thrombus inside the left atrial appendage.
Non-selective LAA angiography (A) and intraprocedural TOE (B,C) showing proximal LAA thrombus (asterisks). D) Angiographic result after LAA closure with the LAmbre device using the no-touch technique. E) Intraprocedural TOE showing the thrombus entrapped by the closure device (asterisk). Echo images courtesy of Dr. EM Balbi, MD. LAA: left atrial appendage; TOE: transoesophageal echocardiography
See this image and copyright information in PMC

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