Left atrial appendage occlusion in patients with atrial fibrillation and high risk of fall: a clinical dilemma or a budgetary issue?

  • Giuseppe D’AnconaEmail author
  • Erdal Safak
  • Hüseyin Ince
Letter to the Editors


In patients with atrial fibrillation (AF), the left atrial appendage (LAA) is a known source of thrombi.

Although oral anticoagulation (OAC) remains the first stroke prevention tool in patients with non-valvular AF, percutaneous or minimally invasive surgical LAA-occlusion (LAAO) and exclusion using different devices have been recently proposed as an alternative in patients with contraindications to long-term OAC therapy [1, 2, 3]. In patients under OAC a history of falls does not seem to be associated with a marked increase in the risk of intracranial hemorrhage [4, 5]. For this reason, the European guidelines for AF-management do not advice OAC withholding and LAAO, unless there is evidence of severe uncontrolled falls (e.g. epilepsy or advanced multisystem atrophy with backwards falls), or in selected patients with dementia (lack of adherence) [6].

We have recently evaluated a 92-year-old gentleman with a history of non-valvular chronic AF, previous bypass surgery, and two...


  1. 1.
    Pison L, Potpara TS, Chen J et al (2015) Left atrial appendage closure-indications, techniques, and outcomes: results of the European Heart Rhythm Association Survey. Europace 17:642–646CrossRefGoogle Scholar
  2. 2.
    Sedaghat A, Al-Kassou B, Vij V et al (2019) Contrast-free, echocardiography-guided left atrial appendage occlusion (LAAo): a propensity-matched comparison with conventional LAAo using the AMPLATZER™ Amulet™ device. Clin Res Cardiol 108:333–340CrossRefGoogle Scholar
  3. 3.
    Fink T, Schlüter M, Tilz RR et al (2018) Correction to: acute and long-term outcomes of epicardial left atrial appendage ligation with the second-generation LARIAT device: a high-volume electrophysiology center experience. Clin Res Cardiol 107:1196CrossRefGoogle Scholar
  4. 4.
    Jacobs LG, Billett HH, Freeman K, Dinglas C, Jumaquio L (2009) Anticoagulation for stroke prevention in elderly patients with atrial fibrillation, including those with falls and/or early-stage dementia: a single-center, retrospective, observational study. Am J Geriatr Pharmacother 7:159–166CrossRefGoogle Scholar
  5. 5.
    Banerjee A, Clementy N, Haguenoer K, Fauchier L, Lip GY (2014) Prior history of falls and risk of outcomes in atrial fibrillation: the loire valley atrial fibrillation project. Am J Med 127:972–978CrossRefGoogle Scholar
  6. 6.
    Kirchhof P, Benussi S, Kotecha D et al (2016) ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefGoogle Scholar
  7. 7.
    Chiu AS, Jean RA, Fleming M, Pei KY (2018) Recurrent falls among elderly patients and the impact of anticoagulation therapy. World J Surg 42:3932–3938CrossRefGoogle Scholar
  8. 8.
    Tilz RR, Potpara T, Chen J et al (2017) Left atrial appendage occluder implantation in Europe: indications and anticoagulation post-implantation. Results of the European Heart Rhythm Association Survey. Europace 19:1737–1742CrossRefGoogle Scholar
  9. 9.
    Lee VW, Tsai RB, Chow IH et al (2016) Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation. BMC Cardiovasc Disord 16:167CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CardiologyVivantes Klinikum im Friedrichshain und Am UrbanBerlinGermany
  2. 2.Rostock University Medical CenterRostockGermany

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