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


Left atrial appendage occlusion has the exciting potential to change the current clinical approach to stroke prophylaxis in patients with AF. The patients expected to derive the most benefit from these alternatives are often those with contraindications to anticoagulation. Randomized controlled trials have been limited to the Watchman device and did not include patients intolerant of anticoagulation. Nonetheless, large observational studies are available that have suggested reduction in stroke risk with the use of Watchman device and ACP/Amulet devices, suggesting similar benefit in patients who received only antiplatelet therapy or no post-procedural therapy compared with those who received short-term post-procedural anticoagulation. There is also growing experience with the Lariat system that utilizes a unique epicardial approach to LAAO, which circumvents the potential need for periprocedural anticoagulation due to lack of a device in the systemic circulation. Further randomized studies are needed to evaluate efficacy and safety of these devices without post-procedural oral anticoagulation in patients with contraindicated to these medications. Based on the available data, the use of LAAO will likely grow tremendously in light of imminent need for alternatives to traditional OAC in patients with AF, even in those with a contraindication to anticoagulation.