Appropriate use criteria of left atrial appendage closure devices: latest evidences

ABSTRACT

Atrial fibrillation is the most common arrythmia and it is linked to an increased risk of stroke. Even if anticoagulation therapy reduces the rate of stroke the benefits of this therapy have to be balanced with the increased risk of hemorrhagic event. Left atrial appendage closure is a valid alternative to long-term anticoagulation in patients with atrial fibrillation and high hemorrhagic risk. Actually new devices with different features have been tested and introduced progressively in the clinical practice. Improvements in preprocedural imaging evaluation and the learning curve of the operators led to percutaneous left atrial appendage closure a safe and effective procedure. A good knowledge of different devices and the technique of implant is necessary for optimization percutaneous left atrial appendage closure and the reduction of complications during the acute phase and follow up.

KEYWORDS:

• Left atriale appedage closure
• stroke
• atrial fibrillation
• Watchman
• Amulet
• Lambre

Article highlights

• Left atrial appendage closure is an effective and safe procedure in patients with atrial fibrillation, high risk of stroke and contraindications for long-term anticoagulant

• Newer evidences suggest the possibility of combining LAAC with anticoagulant therapy in patients with cardio-embolic events despite ongoing antithrombotic therapy

• Due to the high variability of left atrial appendage in size, shape, and spatial relation with the surrounding structure, high quality of intra-procedural imaging is needed.

• Several types of devices with different sizes, materials and shapes are available for different clinical scenarios.