Percutaneous occlusion of the left atrial appendage in nonvalvular atrial fibrillation for the prevention of thromboembolism
NICE state that "..Current evidence suggests that percutaneous occlusion of the left atrial appendage (LAA) is efficacious in reducing the risk of thromboembolic complications associated with non-valvular atrial fibrillation (AF). With regard to safety, there is a risk of life-threatening complications from the procedure, but the incidence of these is low..."
Indications and current treatments
- AF is the irregular and rapid beating of the atria. Patients with AF may be asymptomatic or may have symptoms such as fatigue, palpitations, chest pain, shortness of breath and fainting. They also have an increased risk of thromboembolic stroke. In non-rheumatic AF, thrombi largely develop in the LAA
- patients with AF who are considered to be at high risk of thromboembolic stroke are often treated with warfarin anticoagulation therapy. Surgical intervention may involve obliteration of the LAA through an open or thoracoscopic approach
- do not offer LAAO as an alternative to anticoagulation unless anticoagulation is contraindicated or not tolerated (2)
Outline of the procedure
- percutaneous occlusion of the LAA is usually carried out with the patient under general anaesthesia. Using fluoroscopic guidance, a catheter is advanced through the femoral vein into the right atrium and then into the left atrium via a transseptal puncture. The location of the LAA is confirmed and the size of the LAA orifice is established by transoesophageal echocardiography (TOE). An appropriately sized device is selected and deployed in the mouth of the LAA where it is expanded to fit the space
- the position and patency of the occlusion device may be confirmed postoperatively using echocardiographic imaging.
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