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Left Atrial Appendage Closure

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Abstract

Stroke prevention is the primary goal in atrial fibrillation (AF) given its clinical and socioeconomic impact. With AF, the prevalence of thromboembolic stroke continues to rise and there is an urgent need to develop better strategies of stroke prevention. Warfarin, although effective when used appropriately, is burdened by underutilization, narrow therapeutic windows, and life-threatening bleeding complications. Novel pharmacologic agents have been plagued by off-target toxicity and only modest improvement in bleeding complications over warfarin. Because most thromboemboli arise from the left atrial appendage (LAA), surgical exclusion of the LAA is often used in AF patients undergoing cardiac surgery. Percutaneous device LAA closure has now been developed as an adjunct and as an alternative to pharmacotherapy in patients with AF. Promising randomized data are available with the WATCHMAN device, while several other devices are in various stages of clinical and preclinical development.

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Abbreviations

ACTIVE:

Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events

ASAP:

ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology

CAP:

Continued Access PROTECT AF

EXCLUDE:

Exclusion of the Left Atrial Appendage With the AtriClip LAA Exclusion Device in Patients Undergoing Concomitant Cardiac Surgery

LAAOS:

Left Atrial Appendage Occlusion Study

LAAOS II:

Left Atrial Appendage Occlusion Study II

MATCH:

Management of Atherothrombosis With Clopidogrel in High-Risk Patients

PROTECT AF:

WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation

RE-LY:

Randomized Evaluation of Long-Term Anticoagulation Therapy

SPORTIF:

Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation

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Disclosure

Dr. David R. Holmes Jr and the Mayo Clinic have a financial interest in technology related to this research. That technology has been licensed to Atritech, and the Mayo Clinic and Dr. Holmes have contractual rights to receive future royalties from this license. To date, no royalties have been received by either the Mayo Clinic or Dr. Holmes. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Fellow of Interventional Cardiology, Mayo Clinic, 200 First Street SW, SMH MB 4-523, Rochester, MN, 55905, USA

    Inder M. Singh

  2. Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, SMH MB 4-523, Rochester, MN, 55905, USA

    David R. Holmes Jr

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  1. Inder M. Singh
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Correspondence to David R. Holmes Jr.

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Singh, I.M., Holmes, D.R. Left Atrial Appendage Closure. Curr Cardiol Rep 12, 413–421 (2010). https://doi.org/10.1007/s11886-010-0122-9

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