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Who Should Be Referred for Left Atrial Appendage Occlusion Therapy?

  • Arrhythmia (D Spragg, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 7 million individuals in USA. It is one of the most significant arrhythmias, which accounts for a majority of embolic strokes, especially in elderly individuals. Although oral anti-coagulation is beneficial in lowering the risk of stroke, 1 in 10 patients have a contra-indication to warfarin therapy. Among patients who do tolerate either warfarin or novel oral anticoagulant (NOAC), major or recurrent bleeding, intracranial bleeds, etc. often lead to interruption of anti-coagulation. Previous studies have reported that >90% of cardioemboli in non-valvular atrial fibrillation (NVAF) originate in the left atrial appendage. Left atrial appendage occlusion (LAAO) is currently covered by the Centers for Medicare & Medicaid Services (CMS) as an alternative for stroke prevention in patients with an elevated stroke risk (CHADS2 ≥2 or CHA2DS2-VASc score ≥3) who have appropriate rational for avoiding long-term oral anticoagulation following a shared-decision making process. In this review, we discuss the currently available LAAO devices and more importantly, appropriate patient selection for this strategy.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA

    Sidakpal S. Panaich MD & David R. Holmes Jr MD

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  1. Sidakpal S. Panaich MD
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Correspondence to David R. Holmes Jr MD.

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Sidakpal S. Panaich declares no potential conflicts of interest.

David R. Holmes Jr. shares financial interest with Mayo Clinic in technology related to the research of this article. It has been licensed to Boston Scientific.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Arrhythmia

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Panaich, S.S., Holmes, D.R. Who Should Be Referred for Left Atrial Appendage Occlusion Therapy?. Curr Treat Options Cardio Med 19, 42 (2017). https://doi.org/10.1007/s11936-017-0540-8

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  • DOI: https://doi.org/10.1007/s11936-017-0540-8

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