The management of heart failure remains challenging despite many therapeutic advances. Rigorous clinical trial evidence supports administration of multiple therapies, but utilization of evidence-based treatment remains inconsistent and suboptimal. Disease management programs appear effective, but remain costly and difficult to implement in today's care system. Another approach involves optimizing therapy based on serial monitoring of cardiac biomarkers. Emerging results suggest that guiding therapy based on serial changes in natriuretic peptides may be an effective strategy. Although pilot work has provided encouraging results, appropriately designed, large-scale, prospective randomized trials are needed to confirm these preliminary findings and definitively establish this therapeutic approach.
Atrial fibrillation affects over 2.5 million people in the USA and more than 6 million people in Europe. The most devastating complication of atrial fibrillation is systemic thromboembolism, manifesting as ischemic stroke. The left atrial appendage, accounts for 90% of the atrial thrombi in atrial fibrillation. There are two strategies to prevent left atrial appendage thrombi: long term anticoagulation; and eliminating the source of the thrombus, that is, excision/exclusion of the left atrial appendage surgically or percutaneously. In this review, a detailed discussion of all aspects of the LARIAT device are presented including pre-procedural work up, intra-procedural details and post-procedural complications and follow-up, along with the evidence base in the literature for use of this device.
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