Left atrial appendage occlusion for ischemic stroke prevention in patients with non-valvular atrial fibrillation: clinical expert opinion and consensus statement for the Asian-Pacific region



To develop a consensus statement for left atrial appendage occlusion (LAAO) in Asian-Pacific patients with non-valvular atrial fibrillation (NVAF) at risk of ischemic stroke. The need for such a region-specific consensus was indicated by the relative paucity of clinical evidence for LAAO and oral anticoagulation therapy obtained in Asian-Pacific populations and the specific stroke and bleeding characteristics of this population.


Consensus was developed by discussion and evaluation of available evidence and expert opinions during a 2-day meeting attended by clinical experts from the Asian-Pacific regions.


The consensus statement arrived at provides recommendations based on available evidence and expert opinions regarding LAAO in Asian-Pacific patients. Gaps in the evidence and other areas requiring further research were identified.


LAAO is an alternative device-based therapy in carefully selected patients with NVAF at risk of ischemic stroke. However, evidence for LAAO is primarily obtained from Caucasian populations, and data on LAAO in Asian-Pacific patients are scarce. While the present consensus statement addresses several therapy-related aspects based on careful interpretation of available evidence and expert opinions, other areas require additional evidence derived from Asian-Pacific populations.

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This expert opinion and consensus statement is based on discussions among clinical experts listed below during the Heart & Brain Summit in Bangkok, Thailand, July 13 and 14, 2019. All experts listed below reviewed and agreed with the final consensus manuscript.

T. Akagi, Okayama, Japan; J.L.K. Chan, Hong Kong; C.T. Chi, Vietnam; C-C. Chiu, Chang Hua, Taiwan; A.S.F. Chui, Hong Kong; K. Durongpisitkul, Bangkok, Thailand; E. Harmeiwaty, Jakarta, Indonesia; D. Firman, Jakarta, Indonesia; S. Haifeng, Beijing, China; P.K. Hazra, Kolkata, India; S. Komonchan, Bangkok, Thailand; P.X. Lanh, Ho Chi Minh City, Vietnam; M-C. Lin, Taichung, Taiwan; H.F. Liong, Kuala Lumpur, Malaysia; K. Meemook, Bangkok, Thailand; A.M. Muthuppalaniappan, Kuala Lumpur, Malaysia; N.H.T. My, Ho Chi Minh City, Vietnam; Y. Nakajima, Iwate, Japan; K. Oki, Tokyo, Japan; B. Paul, Kolkata, India; A.T. Prabhakar, Vellore, India; P. Puhl, Sydney, Australia; S. Pumprueg, Bangkok, Thailand; D.A. Quoc, Ho Chi Minh City, Vietnam; V. Samuel, Vellore, India; L. Sanders, Melbourne, Australia; V. Sharma, Singapore; J. Sharp, Sydney, Australia; R. Sharpe, Gold Coast, Australia; E. Tay, Singapore; N.B. Thang, Ho Chi Minh City, Vietnam; D. Wang, Sydney, Australia; A. Wong, Brisbane, Australia; X. Yingqi, Jilin, China; W. Zhanhang, Guangzhou, China.


Organization of the Heart & Brain Summit in Bangkok, Thailand, July 13 and 14, 2019, was logistically and financially supported by Abbott.

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Development of this consensus was initiated following several indications from Asian-Pacific physicians regarding the paucity of clinical evidence for LAAO obtained from Asian-Pacific patients. The consensus presented in this manuscript is the result of discussions during a 2-day consensus meeting in which all contributors listed above participated and provided input to the arrived consensus. These participants were selected based on their expertise and experience in ischemic stroke prevention and LAAO. This manuscript was prepared by Dr. Albers in close collaboration with Dr. Diener and Dr. Lewalter and was reviewed by all authors and by all participants in the consensus meeting.

Corresponding author

Correspondence to Edgar Tay.

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Conflict of interest

Edgar Tay is a speaker and proctor and received an educational grant from Boston Scientific. Jason Sharp is a proctor for Abbott and Boston Scientific. Dennis Wang is a proctor for Abbott. Angus Shing Fung Chui is a proctor for Boston Scientific. Bert Albers received a honorarium from Abbott for preparing this manuscript. In the last 3 years, Hans-Christoph Diener (HCD) received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from Abbott, Bayer Vital, BMS, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic, Pfizer, Portola, Sanofi-Aventis, and WebMD Global. Financial support for research projects was provided by Boehringer Ingelheim. HCD received research grants from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, NIH, Bertelsmann Foundation, and Heinz-Nixdorf Foundation. HCD served as editor of Neurologie up2date, Info Neurologie & Psychiatrie, and Arzneimitteltherapie and is on the editorial board of Lancet Neurology. HCD chairs the Treatment Guidelines Committee of the German Society of Neurology and contributed to the EHRA and ESC guidelines for the treatment of AF. Thorsten Lewalter reported lectures and memberships of advisory boards with modest honoraria for Abbott, Boston Scientific, Lifetech, Bayer, Daiichi Sankyo, Pfizer, and Böhringer Ingelheim. Andrew Wong reports no disclosures or conflicts of interest.

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Societal endorsement: This paper is endorsed by the Asian Pacific Society of Interventional Cardiology (APSIC).

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Tay, E., Paul, B., Sharp, J. et al. Left atrial appendage occlusion for ischemic stroke prevention in patients with non-valvular atrial fibrillation: clinical expert opinion and consensus statement for the Asian-Pacific region. J Interv Card Electrophysiol (2020). https://doi.org/10.1007/s10840-020-00752-8

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  • Left atrial appendage occlusion
  • Atrial fibrillation
  • Ischemic stroke prevention
  • Asian-Pacific region
  • Consensus