Cardiovascular Therapies Targeting Left Atrial Appendage
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Elsevier USA
Abstract
Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion. © 2018 American College of Cardiology Foundation
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Keywords
Anticoagulants, Atrial fibrillation, Cardiac surgical procedures, Stroke, Thromboembolism, Atrial appendage, Heart atria, Humans, Risk adjustment, Anticoagulant agent, Anastomosis leakage, Anticoagulation, Catheter ablation, Cerebrovascular accident, Chads2 score, Device embolization, Dialysis, Drug contraindication, Heart atrium appendage, Heart protection, High risk patient, Homeostasis, Human, Mitral valve surgery, Patient selection, Pericarditis, Persistent atrial fibrillation, Postoperative complication, Priority journal, Review, Risk assessment, Risk factor, Visual analog scale, Complication, Devices, Heart atrium, Heart surgery, Procedures, Surgery