Left Atrial Appendage Occlusion

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. It has a prevalence of 0.4% in the general population, which increases with age (1). Two-thirds of those with AF are considered at high risk of stroke defined as a CHADS₂ score of 2–6 with an adjusted stroke rate of 4.0–18% (2). This score assigns one point each for the presence of congestive heart failure, hypertension, age 75 yr or older, and diabetes mellitus and assigns two points for history of stroke or transient ischemic attack. In this regard, AF accounts for approx 15% of all strokes (3). Anticoagulation with warfarin has consistently demonstrated a significant reduction in stroke of approx 60% when compared to placebo (4). Unfortunately, approx 23% of patients with AF are considered suboptimal candidates for warfarin therapy because of bleeding complications, increased risk of bleeding, allergies to coumarin derivatives, or fear of complications, and thus the benefits of this therapy can be unrealized (5). Stafford and Singer found that anticoagulation was utilized in only about a third of outpatients with AF (6).