Left Atrial Occlusion Device Implantation: the Role of the Echocardiographer

  • David Altszuler
  • Alan F. Vainrib
  • Daniel G. Bamira
  • Ricardo J. Benenstein
  • Anthony Aizer
  • Larry A. Chinitz
  • Muhamed SaricEmail author
Echocardiography (JM Gardin and AH Waller, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Echocardiography


Purpose of Review

Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients.

Recent Findings

A few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in contemporary practice. These devices employ an either exclusive endocardial LAA occlusion approach, such as the Watchman (Boston Scientific, Maple Grove, MN) and Amulet (St. Jude Medical, Minneapolis, MN), or both an endocardial and pericardial (epicardial) approach such as the Lariat procedure (SentreHEART, Palo Alto, CA).


Two- and three-dimension transesophageal echocardiography is critical for patient selection, procedure planning, procedural guidance, and ensuring satisfactory immediate as well as long-term LAA occlusion/exclusion efficacy. This review will provide an overview of the role of the echocardiographer in all aspects of LAA occlusion/exclusion procedures for the most commonly used commercially available devices in current practice.


Left atrial appendage Echocardiography 3D Percutaneous closure 


Compliance with Ethical Standards

Conflict of Interest

David Altszuler, Alan F. Vainrib, Daniel G. Bamira, and Ricardo J. Benenstein declare that they have no conflict of interest.

Anthony Aizer reports grants for research support from Abbott, Inc., Biosense Webster, Inc., Sentreheart, Inc.; and fellowship support grants from Abbott, Inc., Biosense Webster, Inc., and Boston Scientific, Inc.

Larry A. Chinitz reports personal fees and nonfinancial support from Medtronic, Abbott, and St. Jude Medical; grants, personal fees, and nonfinancial support from Biotronik; and personal fees from Pfizer, Biosense Webster, and Boston Scientific.

Muhamed Saric reports being on the Speakers’ bureau for Philips and Medtronic and being on the Advisory board for Siemens.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • David Altszuler
    • 1
  • Alan F. Vainrib
    • 1
  • Daniel G. Bamira
    • 1
  • Ricardo J. Benenstein
    • 1
  • Anthony Aizer
    • 1
  • Larry A. Chinitz
    • 1
  • Muhamed Saric
    • 1
    Email author
  1. 1.Leon H. Charney Division of CardiologyNew York University Langone HealthNew YorkUSA

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