ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

Abstract

Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at five-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban, and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centres and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

“…In the present study, the rate of peri-procedural stroke and cardiac perforations were 2.2% and 0.6%, respectively, without any other major cardiovascular events or death. The low complication incidence, which was in consistency with the previous studies, [ 18 , 19 , 23 , 24 ] suggests no additional peri-procedural risks induced by the combined strategy. Another concern about the one-stop strategy is that the post-ablation atrial edema and stunning might mislead the device size selection, resulting in long-term peri-device leak and device migration.…”

2018 Korean Guideline of Atrial Fibrillation Management

“…Surgical LAA occlusion or exclusion in conjunction with cardiac surgery has been performed with multiple techniques for many decades. The feasibility and safety of surgical LAA occlusion/exclusion were proven in various observational studies 167). However, limited controlled trial data have been published.…”

Cryoablation Combined with Left Atrial Appendage Closure: A Safe and Effective Procedure for Paroxysmal Atrial Fibrillation Patients

“…From the aspect of anticoagulation, all patients received OACs therapy were discontinued (either warfarinor NOACs) for at least 2 months since the procedure in the combined procedure group, whether or not shifted to antiplatelet therapy after the reexamination by TEE at the 3 rd month. Although single LAAC procedure was recommended with anticoagulation (either warfarinor NOACs) for at least 45 days [19], as there was no available guideline to recommend the proper dose and duration for patients underwent combined procedure, it was prolonged to 2 months for the patients and proven to be safe with adequate stroke prevention in most trials [11,20]. Moreover, recently, a case reported by Steven K. Carlson presented that 45-day anticoagulation was not adequate to prevent thrombosis in patients combined procedure [21].…”