Percutaneous Left Atrial Appendage Occlusion in Atrial Fibrillation Patients With a Contraindication to Oral Anticoagulation

A Focused Review

Marin Nishimura; Shiv Sab; Ryan R. Reeves; Jonathan C. Hsu


Europace. 2018;20(9):1412-1419. 

In This Article

The Role of Left Atrial Appendage Occlusion Devices in Electrical Isolation of Left Atrial Appendage

Catheter ablation has been shown to be an effective means of treatment of drug-refractory symptomatic AF.[43,44] Pulmonary veins (PVs) have become the most important target for catheter ablation of AF, yet many extra-PV areas also considered important for initiation and maintenance of AF. Left atrial appendage is an under-recognized trigger implicated in recurrence of AF.[45] In the BELIEF trial, DiBiase et al.[46] demonstrated the success of empirical electrical isolation of LAA resulting in long-term freedom from recurrence of AF. Nonetheless, electrical isolation of LAA with subsequent lack of proper mechanical function in the LAA may be associated with an increased risk of thrombus formation, even despite OAC therapy.[46,47] Mechanical isolation of LAA by LAAO may be an alternative to or offer added protection from stroke in these patients undergoing electrical isolation of LAA. Further studies are needed to establish the safety and efficacy of LAAO devices in patients undergoing electrical isolation of LAA.