Percutaneous occlusion of the left atrial appendage: An expert consensus statement

Arch Cardiovasc Dis. 2015 Aug-Sep;108(8-9):460-7. doi: 10.1016/j.acvd.2015.02.001.

Abstract

Atrial fibrillation (AF) is the most common rhythm disturbance. Among the major thromboembolic complications associated with AF, strokes are foremost, with a 4.4% yearly incidence in the absence of preventive treatment. Therefore, the prevention of these embolic accidents is a priority. While proof of the efficacy of oral anticoagulants (OACs) for this indication is long-standing and convincing, they are associated with haemorrhagic complications. Consequently, their prescription is based on an estimate of the risk (haemorrhagic complications)/benefit (thromboembolic prevention) ratio. In a patient subset at high thromboembolic and haemorrhagic risk, whether to prescribe or abstain from prescribing an OAC is a challenging decision, and an alternative means of thromboembolic prevention is desirable. Percutaneous occlusion of the left atrial appendage (LAA) is an alternative, interventional, non-pharmacological treatment that has been used widely in Europe and for a few years in France, with encouraging results. However, it remains an invasive procedure with a low level of proof in comparison with OACs. Moreover, the indications, the procedural environment and pre-per-post procedural patient management are major questions about this technique, with consequences on its efficacy and risk/benefit ratio. This document, composed by consensus among experts in the field, is an in-depth review of this new therapy.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Atrial Appendage / physiopathology*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / standards*
  • Cardiology / standards*
  • Clinical Competence / standards
  • Consensus
  • Heart Rate
  • Humans
  • Patient Selection
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome