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Curr Cardiol Rep. 2014 Feb;16(2):448. doi: 10.1007/s11886-013-0448-1.

Left atrial appendage exclusion for prevention of stroke in atrial fibrillation: review of minimally invasive approaches.

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  • 1Section of Cardiology, Department of Internal Medicine, University of Chicago, 5758 S. Maryland Ave, MC 9024, Chicago, IL, 60637, USA, jmoss@medicine.bsd.uchicago.edu.

Abstract

Stroke prevention is of vital importance in the management of atrial fibrillation (AF), though the proven strategy of systemic anticoagulation for thromboembolic prophylaxis is underutilized for a variety of reasons. The left atrial appendage (LAA) has long been suspected as the principal source of arterial emboli, particularly in nonvalvular AF, and a variety of techniques for its exclusion from the circulation have been developed. This review highlights the history of the LAA as a target of intervention, and the parallel advances in three minimally invasive strategies for its exclusion: percutaneous occlusion of the LAA orifice from within the left atrium, closed-chest ligation via a percutaneous pericardial approach, and minimally invasive thoracoscopic surgery. While further study is necessary, available evidence suggests that effective LAA exclusion is becoming a viable alternative to anticoagulation for stroke prevention in nonvalvular AF.

PMID:
24408675
[PubMed - indexed for MEDLINE]
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