Left Atrial Appendage Occlusion: Expanding Indications and New Developments
Percutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | Structural Heart |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S247487062400109X |
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| author | Grant W. Reed, MD, MSc Shady Nakhla, MD Rhonda Miyasaka, MD Serge Harb, MD Mohamed Kanj, MD Ousamma Wazni, MD Samir R. Kapadia, MD Amar Krishnaswamy, MD |
| author_facet | Grant W. Reed, MD, MSc Shady Nakhla, MD Rhonda Miyasaka, MD Serge Harb, MD Mohamed Kanj, MD Ousamma Wazni, MD Samir R. Kapadia, MD Amar Krishnaswamy, MD |
| author_sort | Grant W. Reed, MD, MSc |
| collection | DOAJ |
| description | Percutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice. Recent data comparing the safety and efficacy of post-LAAO antiplatelet vs. antithrombotic therapy will be highlighted, with specific recommendations regarding which patients are best suited for each strategy. We will also address the safety and practical considerations provided by emerging trials on concomitant LAAO during other structural heart interventions such as transcatheter aortic valve replacement and mitral valve interventions, as well as electrophysiology procedures including catheter ablation for atrial fibrillation and pacemaker implantation. Practical considerations for the use of transesophageal echocardiography or intracardiac echocardiography for procedural guidance will also be discussed. As the evidence supporting LAAO continues to evolve, this review will serve as a primer on the recent and upcoming advances in device technology and management strategies positioned to further push LAAO forward into the future. |
| format | Article |
| id | doaj-art-c214f762e04a4009ab2cad72ce528cdb |
| institution | Kabale University |
| issn | 2474-8706 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Structural Heart |
| spelling | doaj-art-c214f762e04a4009ab2cad72ce528cdb2025-02-10T04:34:41ZengElsevierStructural Heart2474-87062025-01-0191100354Left Atrial Appendage Occlusion: Expanding Indications and New DevelopmentsGrant W. Reed, MD, MSc0Shady Nakhla, MD1Rhonda Miyasaka, MD2Serge Harb, MD3Mohamed Kanj, MD4Ousamma Wazni, MD5Samir R. Kapadia, MD6Amar Krishnaswamy, MD7Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioAddress correspondence to: Amar Krishnaswamy, MD, Section Head, Interventional Cardiology, Director, Sones Cardiac Catheterization Laboratories, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195.; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioPercutaneous left atrial appendage occlusion (LAAO) is recommended in several major international society guidelines as a viable alternative to therapeutic anticoagulation for the prevention of ischemic stroke in patients with nonvalvular atrial fibrillation or flutter. Recent innovations in device development have improved the safety and procedural success of LAAO, further fueling enthusiasm for expanding its indications beyond patients with high-bleeding risk from oral anticoagulation use. It is the aim of this review to provide historical context in addition to recent updates and upcoming developments and provide practical suggestions on how best to care for patients who are candidates for LAAO in contemporary practice. Recent data comparing the safety and efficacy of post-LAAO antiplatelet vs. antithrombotic therapy will be highlighted, with specific recommendations regarding which patients are best suited for each strategy. We will also address the safety and practical considerations provided by emerging trials on concomitant LAAO during other structural heart interventions such as transcatheter aortic valve replacement and mitral valve interventions, as well as electrophysiology procedures including catheter ablation for atrial fibrillation and pacemaker implantation. Practical considerations for the use of transesophageal echocardiography or intracardiac echocardiography for procedural guidance will also be discussed. As the evidence supporting LAAO continues to evolve, this review will serve as a primer on the recent and upcoming advances in device technology and management strategies positioned to further push LAAO forward into the future.http://www.sciencedirect.com/science/article/pii/S247487062400109XAtrial fibrillationAnticoagulationLeft atrial appendage occlusion |
| spellingShingle | Grant W. Reed, MD, MSc Shady Nakhla, MD Rhonda Miyasaka, MD Serge Harb, MD Mohamed Kanj, MD Ousamma Wazni, MD Samir R. Kapadia, MD Amar Krishnaswamy, MD Left Atrial Appendage Occlusion: Expanding Indications and New Developments Structural Heart Atrial fibrillation Anticoagulation Left atrial appendage occlusion |
| title | Left Atrial Appendage Occlusion: Expanding Indications and New Developments |
| title_full | Left Atrial Appendage Occlusion: Expanding Indications and New Developments |
| title_fullStr | Left Atrial Appendage Occlusion: Expanding Indications and New Developments |
| title_full_unstemmed | Left Atrial Appendage Occlusion: Expanding Indications and New Developments |
| title_short | Left Atrial Appendage Occlusion: Expanding Indications and New Developments |
| title_sort | left atrial appendage occlusion expanding indications and new developments |
| topic | Atrial fibrillation Anticoagulation Left atrial appendage occlusion |
| url | http://www.sciencedirect.com/science/article/pii/S247487062400109X |
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