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World J Cardiol. Feb 26, 2017; 9(2): 139-146
Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.139
Left atrial appendage occlusion: A better alternative to anticoagulation?
Ibrahim Akin, Christoph A Nienaber
Ibrahim Akin, Medical Faculty Mannheim, University Heidelberg, 68167 Mannheim, Germany
Christoph A Nienaber, Royal Brompton Hospital and Harefield Trust, London SW3 6NP, United Kingdom
Author contributions: Both Akin I and Nienaber CA contributed to the paper.
Conflict-of-interest statement: No conflict of interest for all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ibrahim Akin, Professor, Medical Faculty Mannheim, University Heidelberg, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany. ibrahim.akin@umm.de
Telephone: +49-621-3835229 Fax: +49-621-3832012
Received: July 13, 2016
Peer-review started: July 16, 2016
First decision: September 30, 2016
Revised: November 20, 2016
Accepted: December 1, 2016
Article in press: December 3, 2016
Published online: February 26, 2017
Processing time: 224 Days and 17.5 Hours
Abstract

Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke due to blood clot forming predominantly in the left atrial appendage (LAA). Preventive measures to avoid embolic events are permanent administration of anticoagulants or surgical closure of the LAA. Various clinical trials provide evidence about safety, effectiveness and therapeutic success of LAA occlusion using various cardiac occluder devices. The use of such implants for interventional closure of the LAA is likely to become a valuable alternative for stroke prevention, especially in patients with contraindication for oral anticoagulation as safety, clinical benefit and cost-effectiveness of LAA occlusion has recently been demonstrated.

Keywords: Left atrial appendage; Thrombus; Occlude; Stroke

Core tip: Non-valvular atrial fibrillation is associated with increased risk of embolic stroke. To date, risk-based anticoagulation is the cornerstore to avoid this. However, several patients have got absolute or relative contraindication to this and thus are undertreated. For these patient population the implantation of a local left atrial appendage occluder might be an alternative.