Left atrial appendage device closure as non- pharmacological prevention of thromboembolism in atrial fi brillation An article from the series «Atrial fibrillation - update 2014»

Summary The fact that non-valvular (non-rheumatic) atrial fibrillation creates detectable thrombi in 17% of patients without oral anticoagulation and that 16% of the 17% (over 90% relatively) reside in the left atrial appendage (LAA), suggest that patients without an LAA or with an occluded LAA do not need oral anticoagulation. This has already led to surgical LAA exclusion for decades and to catheter-based LAA occlusion for the past 13 years. Currently 5 different technical approaches are approved in European countries, but only 2 are widely used, the Amplatzer and the Watchman devices. With the latter, randomised data showed superiority in terms of embolism protection, bleeding, and survival compared to vitamin K antagonists (VKA) after 4 years in a randomised trial. The clinical results in thousands of patients with Watchman and Amplatzer occluders suggest, moreover, that they are at least competitive with non-VKA oral anticoagulants. Non-pharmacolog ical prevention of thromboembolism with device implantation or, in case of another indication for heart surgery during that intervention, may be discussed with every patient with atrial fibrillation as an alternative to oral anticoagulation.