The Left Atrial Appendage, Including LAA Occlusion Devices Line Watchman, Amulet, and Lariat

Abstract

Atrial fibrillation is a very common arrhythmia whose prevalence is expected to increase significantly as the population ages. The associated stroke risk is a major cause of morbidity and mortality. Stroke prevention by anticoagulation carries its own risks, leading to the search for alternative strategies. Multiple techniques have been developed to exclude the left atrial appendage (the main source of thromboembolism in atrial fibrillation) from the circulation. Such techniques offer the hope of stroke prevention without the risks of anticoagulation. This article describes the percutaneous approaches being currently performed in the United States. Particular emphasis is placed on the use of transesophageal echocardiography to guide these procedures.

Left atrial appendage occlusion using hydrogel coils in a child

“…Experience in children is lacking. 1,2 This case represented a medical dilemma. First, it was unclear whether placing a covered stent alone would result in LAA thrombosis and thromboembolic events.…”

MRI-based training model for left atrial appendage closure

“…Consequently, the atrial septum has to be punctured to implant the occluder in the LAA. Since the anatomical shape of the LAA is highly patient specific, the optimal occluder size [4][5][6] and the position of the optimal puncture site vary [7,8]. The huge variability demands patient-specific identification of LAA dimensions and puncture site to avoid repeated device implantation or multiple transeptal punctures (TSP).…”

“…Fig 4. Examples of a optimal (sheath to the LAA along the LAA's neck axis) and b non-optimal (sheath delivery not along the LAA's neck axis) transseptal puncture site in combination with specific LAA shape…”

Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

“…However, appropriate training is necessary to avoid the mechanical complications associated with LAAO that cause trauma to the LAA/left atrium (LA) and pericardial effusion in 89% of patients in whom perioperative/procedural mishaps are encountered [19] . Accordingly, recent studies advocate transesophageal echocardiography-guided LAAO to minimize the risk of procedural complications and their cardiovascular consequences [20] .…”