Left atrial appendage occlusion

Abstract

Prevention of stroke represents a goal of primary importance in health systems due to its associated morbidity and mortality. As several patient groups with increased stroke rates have been identified, multiple approaches have been developed and implemented: oral anticoagulation (OAC) for patients with atrial fibrillation, surgical and percutaneous revascularisation in patients with carotid disease, device closure for patients with patent foramen ovale, and now, left atrial appendage occlusion (LAAO) for selected patients with non-valvular atrial fibrillation (NVAF). The latter group of patients are the focus of this review which evaluates the pathophysiology, selection of patients, procedural performance, outcomes of treatment both during and post-procedure, adjunctive therapy, complications, and longer-term outcomes. KEYWORDS • anticoagulation • atrial fibrillation • ischaemic stroke • left atrial appendage occlusion e 1039

The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex interventional occlusion procedures

“…were independently able to show, that size selection and implantation supported by computational assisted sizing and modelling can potentially lead to a reduction in the commonly observed peri‐device leaks, seen in up to 40% of cases at post‐procedural LAA closure imaging 29–31 . The incidence of PDL varies between the general device‐design (“plug” vs. “pacifier”) 20 . Up to this time, the consensus remains that a PDL > 5 mm is defined as incomplete LAAO and requires either continuation of anticoagulation or interventional leak closure.…”

“…[29][30][31] The incidence of PDL varies between the general devicedesign ("plug" vs. "pacifier"). 20 Up to this time, the consensus remains that a PDL > 5 mm is defined as incomplete LAAO and requires either continuation of anticoagulation or interventional leak closure.…”

“…Echocardiographic assessment was performed according to current recommendations and guidelines, [18][19][20] including comprehensive transthoracic echocardiography and transesophageal echocardiography. TEE and TTE were performed with commercially-available echocardiographic systems and echocardiography probes allowing acquisition of 2-and 3-dimensional datasets.…”

Echocardiography in Percutaneous Left Atrial Appendage Occlusion and Related Complications

“…42 Limited data on the clinical implications of PDL have led to conflicting findings. So far, the consensus has been that PDL larger than 5 mm indicates incomplete LAAO and necessitates either ongoing anticoagulation or intervention for leak closure 54 (Figure 9).…”

Atrial fibrillation: mechanism and clinical management

“…For patients eligible for OAC therapy, studies have demonstrated that LAAC is non-inferior to warfarin in preventing stroke and SE. [50] The results of the left atrial appendage closure vs. novel anticoagulation agents in AF (PRAGUE-17) study indicate that LAAC is not inferior to NOACs in preventing stroke, SE, major bleeding, or clinically relevant non-major bleeding events, as well as surgery-related complications. [51] Additionally, it significantly reduces clinically relevant non-major bleeding events unrelated to the procedure.…”