Cardiovascular Therapies Targeting Left Atrial Appendage

Mohit K. Turagam; Poonam Velagapudi; Saibal Kar; David Holmes; Vivek Y. Reddy; Marwan M. Refaat; Luigi Di Biase; Amin Al-Ahmed; Mina K. Chung; Thorsten Lewalter; James Edgerton; James Cox; John Fisher; Andrea Natale; Dhanunjaya R. Lakkireddy

doi:10.1016/j.jacc.2018.05.048

Cardiovascular Therapies Targeting Left Atrial Appendage

Mohit K. Turagam, Poonam Velagapudi, Saibal Kar, David Holmes, Vivek Y. Reddy, Marwan M. Refaat, Luigi Di Biase, Amin Al-Ahmed, Mina K. Chung, Thorsten Lewalter, James Edgerton, James Cox, John Fisher, Andrea Natale, Dhanunjaya R. Lakkireddy

Department of Surgery

Research output: Contribution to journal › Review article › peer-review

37 Scopus citations

Abstract

Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.

Original language	English
Pages (from-to)	448-463
Number of pages	16
Journal	Journal of the American College of Cardiology
Volume	72
Issue number	4
DOIs	https://doi.org/10.1016/j.jacc.2018.05.048
State	Published - Jul 24 2018

Keywords

anticoagulants
atrial fibrillation
cardiac surgical procedures
stroke
thromboembolism

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Turagam, M. K., Velagapudi, P., Kar, S., Holmes, D., Reddy, V. Y., Refaat, M. M., Di Biase, L., Al-Ahmed, A., Chung, M. K., Lewalter, T., Edgerton, J., Cox, J., Fisher, J., Natale, A., & Lakkireddy, D. R. (2018). Cardiovascular Therapies Targeting Left Atrial Appendage. Journal of the American College of Cardiology, 72(4), 448-463. https://doi.org/10.1016/j.jacc.2018.05.048

@article{3adf9a9097ec45f682ea4b6a1266e36d,

title = "Cardiovascular Therapies Targeting Left Atrial Appendage",

abstract = "Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.",

keywords = "anticoagulants, atrial fibrillation, cardiac surgical procedures, stroke, thromboembolism",

author = "Turagam, {Mohit K.} and Poonam Velagapudi and Saibal Kar and David Holmes and Reddy, {Vivek Y.} and Refaat, {Marwan M.} and {Di Biase}, Luigi and Amin Al-Ahmed and Chung, {Mina K.} and Thorsten Lewalter and James Edgerton and James Cox and John Fisher and Andrea Natale and Lakkireddy, {Dhanunjaya R.}",

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year = "2018",

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doi = "10.1016/j.jacc.2018.05.048",

language = "English",

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AU - Turagam, Mohit K.

AU - Velagapudi, Poonam

AU - Kar, Saibal

AU - Holmes, David

AU - Reddy, Vivek Y.

AU - Refaat, Marwan M.

AU - Di Biase, Luigi

AU - Al-Ahmed, Amin

AU - Chung, Mina K.

AU - Lewalter, Thorsten

AU - Edgerton, James

AU - Cox, James

AU - Fisher, John

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya R.

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N2 - Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.

AB - Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.

KW - anticoagulants

KW - atrial fibrillation

KW - cardiac surgical procedures

KW - stroke

KW - thromboembolism

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EP - 463

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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ER -

Cardiovascular Therapies Targeting Left Atrial Appendage

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