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Thromb Haemost 2020; 120(11): 1484-1491
DOI: 10.1055/s-0040-1714654
Invited Clinical Focus

Left Atrial Appendage Occlusion: Past, Present and Future

Wern Yew Ding
1   Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
2   Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
,
John Mandrola
3   Department of Cardiology, Baptist Health Louisville, Louisville, Kentucky, United States
,
Dhiraj Gupta
1   Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
2   Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Abstract

There are several situations whereby oral anticoagulation may be unsuitable for stroke prevention in patients with atrial fibrillation (AF). Percutaneous left atrial appendage (LAA) occlusion has received much attention in this area. Various devices have already been developed and tested for this purpose. Data from registries and cohort studies have indicated favourable short- and long-term outcomes with LAA occlusion, and several international guidelines recommend its use in AF patients with contraindications to oral anticoagulation. However, prospective controlled trials in this very population are lacking. Furthermore, while modelling studies on cost analyses have suggested that LAA occlusion may be a cost-effective strategy compared with standard medical therapy, these have not been performed in high-risk patients who may have limited survival in the medium to long term. Thus, while LAA occlusion offers promise, there is a strong need for additional research to investigate its exact role, its long-term outcomes and cost efficacy.

Keywords

left atrial appendage - occlusion - closure - percutaneous - atrial fibrillation


Publication History

Received: 30 April 2020

Accepted: 16 June 2020

Article published online:
27 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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