Left Atrial Appendage Occlusion: A Narrative Review

Ali Alsagheir; Alex Koziarz; Emilie P Belley-Côté; Richard P Whitlock

doi:10.1053/j.jvca.2019.01.054

Left Atrial Appendage Occlusion: A Narrative Review

J Cardiothorac Vasc Anesth. 2019 Jun;33(6):1753-1765. doi: 10.1053/j.jvca.2019.01.054. Epub 2019 Jan 29.

Authors

Ali Alsagheir¹, Alex Koziarz², Emilie P Belley-Côté³, Richard P Whitlock⁴

Affiliations

¹ Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
² Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
³ Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
⁴ Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada. Electronic address: Richard.Whitlock@phri.ca.

PMID: 30857852
DOI: 10.1053/j.jvca.2019.01.054

Abstract

Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. Despite the increase in evidence evaluating LAAO, the relative safety and efficacy of the procedure remains uncertain. Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation. The objectives of this narrative review were to present the evidence on percutaneous and surgical LAAO devices, review current guidelines, and summarize landmark trials.

Keywords: atrial fibrillation; left atrial appendage; prevention; stroke.

Publication types

Review

MeSH terms

Atrial Appendage / surgery*
Atrial Fibrillation / complications
Atrial Fibrillation / surgery*
Cardiac Surgical Procedures / methods*
Humans
Septal Occluder Device*
Stroke / etiology
Stroke / prevention & control*