Left Atrial Appendage Occlusion in the Management of Stroke in Patients With Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is associated with a substantially higher risk of thromboembolism, particularly stroke events, resulting in significant morbidity and mortality. Oral anticoagulation (OAC), while effective in reducing embolic events in AF patients, is associated with an increased bleeding risk. Thus, not all patients with AF are candidates for OAC and some are only candidates for OAC in the short term. Of the available nonpharmacologic strategies for the management of AF, left atrial appendage occlusion (LAAO) has emerged as a potential approach for reducing the risk of systemic thromboembolism in AF patients eligible for OAC. LAAO can be achieved either surgically or percutaneously using an epicardial, endocardial, or a combined approach. Although available data are limited, currently available LAAO devices, and those being developed, have shown promise in reducing bleeding risk in AF patients because of the reduced overall need for anticoagulation, while maintaining efficacy in preventing thromboembolism. The optimal device will reduce both embolic and hemorrhagic strokes, and other bleeds, with a high implant success rate and a low complication rate. Until that time, anticoagulation remains the gold standard that these devices strive to surpass, and thus LAAO devices are currently indicated in patients with relative contraindication to OAC therapy.

Long-Term Effect of Left Atrial Appendage Occlusion in Treating Patients with Previous Ischemic Stroke on the Disease Recurrence

“…Roman-Gonzalez et al [24] proposed that patients with IS are resistant to aspirin, which is implicated with IS recurrence. Earlier investigations believed that LAAO is an efficacious preventive therapy for thrombosis, especially for patients with previous IS, and a warfarin contraindication or advanced age [13]. Phillips et al [25] carried out a study on 201 patients with nonvalvular atrial fibrillation undergoing LAAO, and after the procedure, they are prescribed novel oral anticoagulant.…”

“…The guide wire is usually placed in LAA through puncture of femoral vein under local anesthesia, and then, the occluder is inserted. The occluder is capable of preventing thromboembolism and reducing risk of stroke, and thus, LAAO is considered an effective preventive therapy for thrombosis [13]. Multiple pieces of clinical research have verified the efficacy of LAAO in preventing nonvalvular atrial fibrillation stroke.…”