Left atrial appendage occlusion: consensus document of Association of Cardiovascular Interventions and Heart Rhythm Section of Polish Cardiac Society

Abstract

Left atrial appendage (LAA) occlusion devices have the potential to influence the clinical approach to stroke prevention in patients with atrial fibrillation. A number of percutaneous techniques have been proposed, including various intracardiac plugs and also external ligation. Several devices have been already used in Poland. One of them has been evaluated in randomised controlled trials compared with the current standard of care. Others are less well studied but quite commonly used in Eu-rope. It is anticipated that the use of LAA occlusion technologies in clinical practice will expand. This Consensus Document prepared jointly by Association of Cardiovascular Interventions (AISN) and Heart Rhythm Section (HRS) of Polish Cardiac Society seeks to highlight the critical issues surrounding LAA occlusion therapies and to facilitate the alignment of multiple interests, including those of primary care physicians, general cardiologists and procedural specialists (electrophysiologists and interventional cardiologists) but also other medical professionals. The article summarises current evidence and provides spe-cific recommendations on organisation and conduct of LAA therapy in patients with atrial fibrillation in Poland and defines also operator and institutional requirements fundamental to the establishment of successful LAA occlusion programmme.

Long term outcomes after left atrial appendage closure with the LARIAT device—Stroke risk reduction over five years follow-up

“…ESC guidelines now include LAAC as a Class 2 B recommendation for patients with AF with a contraindication to OAC or a clinical history of severe bleeding [1]. Some cardiology associations are also starting to expand LAAC indications to include patients in whom OAC is ineffective [2].…”

“…Left atrial appendage closure (LAAC) for stroke prevention in patients with atrial fibrillation (AF) is one of the fastest developing branches of interventional cardiology with the number of procedures rising annually. Currently, LAAC procedures are a recommended alternative for AF patients in whom oral anticoagulation (OAC) therapy is ineffective or contraindicated [1,2].…”

Reduction in risk of stroke and bleeding after left atrial appendage closure with LARIAT device in patients with increased risk of stroke and bleeding: Long term results

“…8 procedures are currently one of the fastest developing branches of interventional cardiology and indications for LAAO are extending. 1,4,9,10 Previous short-term studies showed that LAAO procedures are efficacious, safe and are widely performed in clinical practice. 11 However, few published studies evaluate the long-term efficacy of LAAO procedures in high risk patients based on CHA 2 DS 2 -VAS-score.…”

“…In recent years left atrial appendage occlusion (LAOO) has become an alternative treatment for stroke prevention in AF patients regardless of patients age . LAAO procedures are currently one of the fastest developing branches of interventional cardiology and indications for LAAO are extending . Previous short‐term studies showed that LAAO procedures are efficacious, safe and are widely performed in clinical practice .…”

Antithrombotic/Antiplatelet Treatment in Transcatheter Structural Cardiac Interventions—PFO/ASD/LAA Occluder and Interatrial Shunt Devices

“…Patients with contraindication for oral anticoagulants, who constitute majority of population qualified to LAA closure at least in Europe, receive DAPT as a reasonable alternative based on the large registries (38). The multicenter, prospective, nonrandomized ASAP study (28) was the first one conducted in patients who were considered ineligible for even short term treatment with warfarin.…”