Mechanical antithrombotic intervention by laa occlusion in atrial fibrillation

KEY POINTS * Oral anticoagulation, using apixaban, dabigatran, rivaroxaban, or warfarin is the first-line therapy for stroke prevention in patients with atrial fibrillation (AF), an approach

limited by an increased risk of haemorrhage * Percutaneous transcatheter occlusion of the left atrial appendage (LAA), where >90% of thrombi form in patients with nonrheumatic AF, is an

attractive nonpharmacological option for individuals intolerant to oral anticoagulants * Limited evidence suggests that mechanical LAA occlusion can be superior to oral anticoagulation

therapy with warfarin in preventing stroke, systemic embolism, and cardiovascular-related or unexplained death in patients with AF * Echocardiographic imaging of the LAA has an important

role in the occlusion procedure by guiding device sizing, delivery, and deployment * Operator experience is crucial in influencing the rate of procedure-related complications associated with

percutaneous transcatheter LAA occlusion * Evidence is emerging, but substantial efforts are warranted to understand better the role of LAA occlusion in stroke prevention, especially in

patients with AF and contraindications for oral anticoagulation therapy ABSTRACT Stroke in patients with atrial fibrillation (AF) is often associated with substantial morbidity and

mortality. Oral anticoagulation remains the first-line approach to stroke prevention in such individuals; however, for a considerable proportion of patients, traditional treatment using

warfarin is limited by a number of factors, such as the inconvenience of frequent therapeutic monitoring and the risk of haemorrhage. The development of new oral anticoagulants with improved

efficacy and safety profiles has provided viable options for oral anticoagulation therapy in patients with nonvalvular (nonrheumatic AF). Nonetheless, in patients who have an increased risk

of major haemorrhage, a nonpharmacological approach to antithrombotic therapy remains an attractive alternative. The left atrial appendage (LAA) has been found to be the source of >90%

of thrombi in patients with nonvalvular AF; thus, prevention of thrombus formation via transcatheter mechanical LAA occlusion is a novel therapeutic target for stroke prevention in this

patient population. In this Review, we present the rationale for LAA occlusion in patients with AF, the available occlusion devices and their clinical evidence to date. We also discuss the

roles of various imaging techniques in device implantation and the management strategy for associated procedural complications. Access through your institution Buy or subscribe This is a

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APPENDAGE THROMBUS FORMATION, POTENTIAL OF RESOLUTION AND ASSOCIATION WITH PROGNOSIS IN A LARGE REAL-WORLD COHORT Article Open access 17 January 2023 MIDTERM OUTCOMES OF LAA OCCLUSION WITH

THE AMPLATZER CARDIAC PLUG AND AMPLATZER AMULET DEVICES IN A HIGH-RISK COHORT Article Open access 01 October 2020 STROKE PREVENTION STRATEGIES IN HIGH-RISK PATIENTS WITH ATRIAL FIBRILLATION

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references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Prince of Wales Hospital, The

Chinese University of Hong Kong, Hong Kong SAR, Shatin, NT, China Cheuk-Man Yu, Alex P. W. Lee & Joey S. W. Kwong * Department of Cardiology, Swiss Cardiovascular Centre Bern, Bern

University Hospital, Bern, 3010, Switzerland Ahmed A. Khattab & Bernhard Meier * CardioVascular Centre Frankfurt, Sankt Katharinen, Seckbacher Landstrasse 65, Frankfurt, 60389, Germany

Stefan C. Bertog & Horst Sievert Authors * Cheuk-Man Yu View author publications You can also search for this author inPubMed Google Scholar * Ahmed A. Khattab View author publications

You can also search for this author inPubMed Google Scholar * Stefan C. Bertog View author publications You can also search for this author inPubMed Google Scholar * Alex P. W. Lee View

author publications You can also search for this author inPubMed Google Scholar * Joey S. W. Kwong View author publications You can also search for this author inPubMed Google Scholar *

Horst Sievert View author publications You can also search for this author inPubMed Google Scholar * Bernhard Meier View author publications You can also search for this author inPubMed 

Google Scholar CONTRIBUTIONS All the authors researched data for the article, contributed substantially to discussion of its contents, and wrote the manuscript. C.-M. Yu reviewed/edited the

manuscript before submission. CORRESPONDING AUTHOR Correspondence to Cheuk-Man Yu. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing financial interests. POWERPOINT

SLIDES POWERPOINT SLIDE FOR FIG. 1 POWERPOINT SLIDE FOR FIG. 2 POWERPOINT SLIDE FOR FIG. 3 POWERPOINT SLIDE FOR FIG. 4 POWERPOINT SLIDE FOR FIG. 5 POWERPOINT SLIDE FOR TABLE 1 POWERPOINT

SLIDE FOR TABLE 2 POWERPOINT SLIDE FOR TABLE 3 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Yu, CM., Khattab, A., Bertog, S. _et al._ Mechanical

antithrombotic intervention by LAA occlusion in atrial fibrillation. _Nat Rev Cardiol_ 10, 707–722 (2013). https://doi.org/10.1038/nrcardio.2013.158 Download citation * Published: 22 October

2013 * Issue Date: December 2013 * DOI: https://doi.org/10.1038/nrcardio.2013.158 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get

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