Risks and Benefits of Removal of the Left Atrial Appendage
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INVASIVE ELECTROPHYSIOLOGY AND PACING (E. KEVIN HEIST, SECTION EDITOR)
Risks and Benefits of Removal of the Left Atrial Appendage Ghulam Murtaza 1 & Urooge Boda 1 & Mohit K. Turagam 2 & Domenico G. Della Rocca 3 & Krishna Akella 1 & Rakesh Gopinathannair 1 & Dhanunjaya Lakkireddy 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In patients with atrial fibrillation who are unable to take novel oral anticoagulants for stroke prophylaxis due to bleeding risk or other contraindications, left atrial appendage (LAA) occlusion and exclusion devices have shown benefit. In this review, we highlight the risks and benefits associated with LAA removal. Recent Findings LAA, once considered a vestigial organ, has been shown to have physiological, anatomical, and arrhythmogenic properties. Device-related complications such as pericardial effusion, device embolization, device-related thrombus, while uncommon, are still present. With increased operator experience related to appendage occlusion, overall procedural complications have declined. Further refinements in device technology will help decrease complications. Summary While benefits of appendage removal are plenty, procedural complications need to be weighed into the equation when making decisions regarding LAA occlusion. Keywords Benefits of left atrial appendage removal . Risks of atrial appendage removal . Endocardial occlusion benefits . Epicardial exclusion benefits . Watchman . LARIAT
Introduction More than 3 million Americans have atrial fibrillation (AF), a condition in which there is an irregular activation of the atria of the heart leading to loss of atrial contraction [1]. AF increases the risk of stroke by 3–5 times, as it is associated with an increased systemic hypercoagulable state [2]. Hence, it is one of the leading causes of ischemic stroke. Data from echocardiograms and autopsy studies show that 70% of all strokes due to AF are cardioembolic from the left atrium (LA), with
90% of emboli arising from the left atrial appendage (LAA) [3], a vestigial structure derived from the embryonic LA [4]. In AF, blood pools in the LAA and can lead to thrombus formation. In order to reduce the risk of stroke in these situations, AF patients must receive therapy with oral anticoagulants (OACs) or LAA occlusion procedures. OAC is the treatment of choice for thromboembolism; however, not only does it remain underutilized, it is also under-prescribed and has poor adherence rates. Approximately 10% of patients have a relative or
This article is part of the Topical Collection on Invasive Electrophysiology and Pacing * Dhanunjaya Lakkireddy [email protected]
Krishna Akella [email protected]
Ghulam Murtaza [email protected] Urooge Boda [email protected] Mohit K. Turagam [email protected] Domenico G. Della Rocca [email protected]
Rakesh Gopinathannair [email protected] 1
The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center,
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