Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation

J Am Heart Assoc. 2021 Nov 2;10(21):e022274. doi: 10.1161/JAHA.121.022274. Epub 2021 Oct 20.

Abstract

The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke prevention in nonvalvular atrial fibrillation. A thorough review of the history of surgical and percutaneous left atrial appendage occlusion devices, recent trials, and US Food and Drug Administration milestones of current left atrial appendage occlusion devices are discussed.

Keywords: atrial fibrillation; left atrial appendage; left atrial appendage occlusion; stroke.

MeSH terms

  • Anticoagulants / therapeutic use
  • Atrial Appendage* / surgery
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / therapy
  • Hemorrhage
  • Humans
  • Stroke* / etiology
  • Stroke* / prevention & control

Substances

  • Anticoagulants