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Review
. 2023 Aug 25;12(17):5524.
doi: 10.3390/jcm12175524.

Non-Pharmacological Stroke Prevention in Atrial Fibrillation

Iñigo Anduaga  1 , Alessandro Affronti  2 , Pedro Cepas-Guillén  1 , Jorge Alcocer  2 , Eduardo Flores-Umanzor  1 , Ander Regueiro  1 , Salvatore Brugaletta  1 , Eduard Quintana  2   3 , Laura Sanchis  1 , Manel Sabaté  1 , Xavier Freixa  1
Affiliations
Review

Non-Pharmacological Stroke Prevention in Atrial Fibrillation

Iñigo Anduaga et al. J Clin Med. .

Abstract

Atrial fibrillation (AF) is the most common arrhythmia worldwide. It is associated with increased mortality and morbidity, especially due to the increased risk of ischemic stroke and systemic embolism in these patients. For this reason, thromboembolism prevention is the cornerstone of managing AF, and oral anticoagulation is nowadays the first-line treatment. However, since most thrombi form in the left atrial appendage and anticoagulant therapy may have side effects and be contraindicated in some patients, surgical and percutaneous left atrial appendage occlusion (LAAO) have emerged as a non-pharmacological alternative. This review summarizes all existing evidence on surgical and percutaneous LAAO.

Keywords: atrial fibrillation; left atrial appendage occlusion; oral anticoagulation; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Left atrial appendage surgical exclusion by occlusion technique. (a) AtriClip in positioning by left thoracoscopy. (b) Measurement and implantation of AtriClip by median sternotomy.
Figure 2
Figure 2
Primary postprocedural complications. (a) Device-related thrombus. Transesophageal echocardiogram. Midesophageal plane at 33°. It shows a large thrombus (46 × 35 mm) that covers the entire device and extends along the entire surface of the Marshall ligament. (b) Peri-device leak. Transesophageal echocardiogram. Midesophageal plane at 33°. It shows a significant gap between the pulmonary ridge and the device.
Figure 3
Figure 3
Percutaneous LAAO device categories. (a) Plug-based devices. Transesophageal echocardiogram. Midesophageal plane at 49°. Plug-based WATCHMAN FLX™ device. (b) Disc-/lobe-based devices. Transesophageal echocardiogram. Midesophageal plane at 73°. Disc-/lobe-based Amplatzer™ Amulet™ device.
See this image and copyright information in PMC

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