Skip to main content
SpringerLink
Log in

Left Atrial Appendage Exclusion for Prevention of Stroke in Atrial Fibrillation: Review of Minimally Invasive Approaches

  • Echocardiography (RM Lang, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Stroke prevention is of vital importance in the management of atrial fibrillation (AF), though the proven strategy of systemic anticoagulation for thromboembolic prophylaxis is underutilized for a variety of reasons. The left atrial appendage (LAA) has long been suspected as the principal source of arterial emboli, particularly in nonvalvular AF, and a variety of techniques for its exclusion from the circulation have been developed. This review highlights the history of the LAA as a target of intervention, and the parallel advances in three minimally invasive strategies for its exclusion: percutaneous occlusion of the LAA orifice from within the left atrium, closed-chest ligation via a percutaneous pericardial approach, and minimally invasive thoracoscopic surgery. While further study is necessary, available evidence suggests that effective LAA exclusion is becoming a viable alternative to anticoagulation for stroke prevention in nonvalvular AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

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

  1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (atria) study. JAMA. 2001;285:2370–5.

    Article  CAS  PubMed  Google Scholar 

  2. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994, 154:1449–57.

    Google Scholar 

  3. Wolf PA, Dawber TR, Thomas HE, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28:973–7.

    Article  CAS  PubMed  Google Scholar 

  4. Wolf PA, Benjamin EJ, Belanger AJ, et al. Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J. 1996;131:790–5.

    Article  CAS  PubMed  Google Scholar 

  5. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82:2N–9.

    Article  CAS  PubMed  Google Scholar 

  6. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet 1996,348:633–8.

  7. Petersen P, Boysen G, Godtfredsen J, et al. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989;1:175–9.

    Article  CAS  PubMed  Google Scholar 

  8. Connolly SJ, Laupacis A, Gent M, et al. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol. 1991;18:349–55.

    Article  CAS  PubMed  Google Scholar 

  9. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. N Engl J Med 1990, 323:1505–11.

    Google Scholar 

  10. Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. 1991;84:527–39.

    Article  Google Scholar 

  11. Ezekowitz MD, Bridgers SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med. 1992;327:1406–12.

    Article  CAS  PubMed  Google Scholar 

  12. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994, 343:687–91.

  13. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993, 342:1255–62.

  14. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  CAS  PubMed  Google Scholar 

  15. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365:883–91.

    Article  CAS  PubMed  Google Scholar 

  16. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011;365:981–92.

    Article  CAS  PubMed  Google Scholar 

  17. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.

    Article  CAS  PubMed  Google Scholar 

  18. van Walraven C, Hart RG, Wells GA, et al. A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin. Arch Intern Med. 2003;163:936–43.

    Article  PubMed  Google Scholar 

  19. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263–72.

    Article  PubMed  Google Scholar 

  20. Van Staa TP, Setakis E, Di Tanna GL, et al. A comparison of risk stratification schemes for stroke in 79,884 atrial fibrillation patients in general practice. J Thromb Haemost. 2011;9:39–48.

    Article  PubMed  Google Scholar 

  21. Go AS, Hylek EM, Borowsky LH, et al. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med. 1999;131:927–34.

    Article  CAS  PubMed  Google Scholar 

  22. Waldo AL, Becker RC, Tapson VF, Colgan KJ, Committee NS. Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005;46:1729–36.

    Article  PubMed  Google Scholar 

  23. Birman-Deych E, Radford MJ, Nilasena DS, Gage BF. Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation. Stroke. 2006;37:1070–4.

    Article  CAS  PubMed  Google Scholar 

  24. Piccini JP, Mi X, DeWald TA, et al. Pharmacotherapy in Medicare beneficiaries with atrial fibrillation. Heart Rhythm. 2012;9:1403–8.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Sandhu RK, Bakal JA, Ezekowitz JA, McAlister FA. Risk stratification schemes, anticoagulation use and outcomes: the risk–treatment paradox in patients with newly diagnosed non-valvular atrial fibrillation. Heart. 2011;97:2046–50.

    Article  PubMed  Google Scholar 

  26. Beyth RJ, Antani MR, Covinsky KE, et al. Why isn't warfarin prescribed to patients with nonrheumatic atrial fibrillation? J Gen Intern Med. 1996;11:721–8.

    Article  CAS  PubMed  Google Scholar 

  27. Gage BF, Boechler M, Doggette AL, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke. 2000;31:822–7.

    Article  CAS  PubMed  Google Scholar 

  28. Garvin CF. Mural thrombi in the heart. Am Heart J. 1941;21:713–20.

    Article  Google Scholar 

  29. Hellerstein HK, Sinaiko E, Dolgin M. Amputation of the canine atrial appendages. Proc Soc Exp Biol Med. 1947;66:337.

    Article  CAS  PubMed  Google Scholar 

  30. Madden JL. Resection of the left auricular appendix; a prophylaxis for recurrent arterial emboli. J Am Med Assoc. 1949;140:769–72.

    Article  CAS  PubMed  Google Scholar 

  31. Slater AD, Tatooles AJ, Coffey A, et al. Prospective clinical study of a novel left atrial appendage occlusion device. Ann Thorac Surg. 2012;93:2035–8.

    Article  PubMed  Google Scholar 

  32. Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device: early results of a multicenter trial. J Thorac Cardiovasc Surg. 2011;142:1002–9. 1009.e1.

    Article  PubMed  Google Scholar 

  33. Kamohara K, Fukamachi K, Ootaki Y, et al. Evaluation of a novel device for left atrial appendage exclusion: the second-generation atrial exclusion device. J Thorac Cardiovasc Surg. 2006;132:340–6.

    Article  PubMed  Google Scholar 

  34. DiSesa VJ, Tam S, Cohn LH. Ligation of the left atrial appendage using an automatic surgical stapler. Ann Thorac Surg. 1988;46:652–3.

    Article  CAS  PubMed  Google Scholar 

  35. Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg. 1991;101:584–92.

    CAS  PubMed  Google Scholar 

  36. Coulshed N, Epstein EJ, McKendrick CS, et al. Systemic embolism in mitral valve disease. Br Heart J. 1970;32:26–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Johnson WD, Ganjoo AK, Stone CD, et al. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg. 2000;17:718–22.

    Article  CAS  PubMed  Google Scholar 

  38. Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiograhic study. J Am Coll Cardiol. 2000;36:468–71.

    Article  CAS  PubMed  Google Scholar 

  39. García-Fernández MA, Pérez-David E, Quiles J, et al. Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis: a transesophageal echocardiographic study. J Am Coll Cardiol. 2003;42:1253–8.

    Article  PubMed  Google Scholar 

  40. Bando K, Kobayashi J, Hirata M, et al. Early and late stroke after mitral valve replacement with a mechanical prosthesis: risk factor analysis of a 24-year experience. J Thorac Cardiovasc Surg. 2003;126:358–64.

    Article  PubMed  Google Scholar 

  41. Blackshear JL, Johnson WD, Odell JA, et al. Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation. J Am Coll Cardiol. 2003;42:1249–52.

    Article  PubMed  Google Scholar 

  42. Pennec PY, Jobic Y, Blanc JJ, et al. Assessment of different procedures for surgical left atrial appendage exclusion. Ann Thorac Surg. 2003;76:2168–9.

    Article  PubMed  Google Scholar 

  43. Schneider B, Stollberger C, Sievers HH. Surgical closure of the left atrial appendage - a beneficial procedure? Cardiology. 2005;104:127–32.

    Article  PubMed  Google Scholar 

  44. Healey JS, Crystal E, Lamy A, et al. Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J. 2005;150:288–93.

    Article  PubMed  Google Scholar 

  45. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol. 2008;52:924–9.

    Article  PubMed  Google Scholar 

  46. Bakhtiary F, Kleine P, Martens S, et al. Simplified technique for surgical ligation of the left atrial appendage in high-risk patients. J Thorac Cardiovasc Surg. 2008;135:430–1.

    Article  PubMed  Google Scholar 

  47. Chatterjee S, Alexander JC, Pearson PJ, Feldman T. Left atrial appendage occlusion: lessons learned from surgical and transcatheter experiences. Ann Thorac Surg. 2011;92:2283–92.

    Article  PubMed  Google Scholar 

  48. Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374:534–42.

    Article  CAS  PubMed  Google Scholar 

  49. Reddy VY, Holmes D, Doshi SK, et al. Safety of Percutaneous Left Atrial Appendage Closure: Results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) Clinical Trial and the Continued Access Registry. Circulation. 2011;123:417–24. The Continued Access Registry demonstrated that safety outcomes, a principle concern in the original PROTECT AF study, improved with procedural experience with the WATCHMAN device.

    Article  PubMed  Google Scholar 

  50. Reddy VY, Doshi SK, Sievert H, et al. Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation: 2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) Trial. Circulation. 2013;127:720–9. Intermediate-term results of the PROTECT AF trial, comparing LAA occlusion using the WATCHMAN device and oral anticoagulation with warfarin. In showing non-inferiority of LAA occlusion, this pivotal study is also the first prospective, randomized trial to implicate the LAA as the source of stroke in nonvalvular atrial fibrillation—long suspected but never before proven.

    Article  PubMed  Google Scholar 

  51. Reddy VY, Möbius-Winkler S, Miller MA, et al. Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation: The ASAP Study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology). J Am Coll Cardiol. 2013;61:2551–6.

    Article  PubMed  Google Scholar 

  52. Viles-Gonzalez JF, Kar S, Douglas P, et al. The clinical impact of incomplete left atrial appendage closure with the watchman device in patients with atrial fibrillation: A PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients with Atrial Fibrillation) substudy. J Am Coll Cardiol. 2012;59:923–9. This substudy of the pivotal PROTECT AF trial was limited by overall low event rates. However, it showed that the commonly seen residual peri-device flow after WATCHMAN implantation was not associated with increased stroke risk, suggesting that near-complete exclusion of the LAA was adequate protection from thromboembolism.

    Article  PubMed  Google Scholar 

  53. PREVAIL Study: Prospective Randomized Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy. Available at http://www.bostonscientific.com/watchman-eu/clinical-data/prevail-clinical-study.html. Accessed August 2013.

  54. Park JW, Bethencourt A, Sievert H, et al. Left atrial appendage closure with Amplatzer Cardiac Plug in atrial fibrillation: Initial European experience. Catheter Cardiovasc Interv. 2011;77:700–6.

    Article  PubMed  Google Scholar 

  55. Urena M, Rodés-Cabau J, Freixa X, et al. Percutaneous Left Atrial Appendage Closure With the AMPLATZER Cardiac Plug Device in Patients With Nonvalvular Atrial Fibrillation and Contraindications to Anticoagulation Therapy. J Am Coll Cardiol. 2013;62:96–102. Intermediate-term follow-up results from this multicenter experience with the Amplatzer Cardiac Plug showed a lower stroke rate at mean follow-up of 20 months than would be expected based on enrollees CHA 2 DS 2 -VASc scores.

    Article  PubMed  Google Scholar 

  56. Cheng Y, McGregor J, Sommer R, et al. Safety and Biocompatibility of the Coherex WaveCrest Left Atrial Appendage Occluder in a 30-Day Canine Study. Miami: Transcatheter Cardiovascular Therapeutics (TCT) 2012; 2012.

    Google Scholar 

  57. Kanthan A, Looi KL, Mottram P, et al.: Percutaneous Left Atrial Appendage Closure Using a PFO Closure Device. Heart Lung Circ 2013.

  58. Toumanides S, Sideris EB, Agricola T, Moulopoulos S. Transcatheter Patch Occlusion of the Left Atrial Appendage Using Surgical Adhesives in High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol. 2011;58:2236–40.

    Article  PubMed  Google Scholar 

  59. Lam Y-Y. A new left atrial appendage occluder (Lifetech LAmbre TM Device) for stroke prevention in atrial fibrillation. Cardiovasc Revascularization Med. 2013;14:134–6.

    Article  Google Scholar 

  60. Bartus K, Bednarek J, Myc J, et al. Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm. 2011;8:188–93.

    Article  PubMed  Google Scholar 

  61. Bartus K, Han FT, Bednarek J, et al. Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation: Initial Clinical Experience. J Am Coll Cardiol. 2013;62:108–18. The initial clinical experience with a device for closed-chest, percutaneous LAA ligation showed a high implant success rate, with suggestion of more complete exclusion based on color Doppler flow than is generally seen with endocardial LAA occlusion devices.

    Article  PubMed  Google Scholar 

  62. Friedman PA, Asirvatham SJ, Dalegrave C, et al. Percutaneous epicardial left atrial appendage closure: preliminary results of an electrogram guided approach. J Cardiovasc Electrophysiol. 2009;20:908–15.

    Article  PubMed  Google Scholar 

  63. Bruce CJ, Stanton CM, Asirvatham SJ, et al. Percutaneous epicardial left atrial appendage closure: intermediate-term results. J Cardiovasc Electrophysiol. 2011;22:64–70.

    Article  PubMed  Google Scholar 

  64. Ohtsuka T, Ninomiya M, Nonaka T, et al. Thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation. J Am Coll Cardiol. 2013;62:103–7. A single-center trial demonstrating safety and efficacy of thoracoscopic left atrial appendectomy in patients at high risk for thromboembolism.

    Article  PubMed  Google Scholar 

  65. Nakai T, Lesh MD, Gerstenfeld EP, et al. Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism: First Experience in Canine Model. Circulation. 2002;105:2217–22.

    Article  PubMed  Google Scholar 

  66. Sievert H, Lesh MD, Trepels T, et al. Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation: Early Clinical Experience. Circulation. 2002;105:1887–9.

    Article  PubMed  Google Scholar 

  67. Ostermayer SH, Reisman M, Kramer PH, et al. Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO System) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: Results from the international multi-center feasibility trials. J Am Coll Cardiol. 2005;46:9–14.

    Article  PubMed  Google Scholar 

  68. Park JW, Leitḧauser B, Gerk U, et al. Percutaneous left atrial appendage transcatheter occlusion (PLAATO) for stroke prevention in atrial fibrillation: 2-year outcomes. J Invasive Cardiol. 2009;21:446–50.

    PubMed  Google Scholar 

  69. Ussia GP, Mulè M, Cammalleri V, et al. Percutaneous closure of left atrial appendage to prevent embolic events in high-risk patients with chronic atrial fibrillation. Catheter Cardiovasc Interv. 2009;74:217–22.

    Article  PubMed  Google Scholar 

  70. Block PC, Burstein S, Casale PN, et al. Percutaneous Left Atrial Appendage Occlusion for Patients in Atrial Fibrillation Suboptimal for Warfarin Therapy. 5-Year Results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study. J Am Coll Cardiol Intv. 2009;2:594–600.

    Article  Google Scholar 

  71. Bayard YL, Omran H, Neuzil P, et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients: Results from the European PLAATO study. EuroIntervention. 2010;6:220–6.

    Article  PubMed  Google Scholar 

  72. Reddy V, Doshi S, Sievert H, et al.: Long Term Results Of Protect AF: The Mortality Effects Of Left Atrial Appendage Closure Versus Warfarin For Stroke Prophylaxis In AF. Presented at Heart Rhythm 2013: 34th Annual Scientific Sessions. Denver, CO, 2013.

  73. Meier B, Palacios I, Windecker S, et al. Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation. Catheter Cardiovasc Interv. 2003;60:417–22.

    Article  PubMed  Google Scholar 

  74. Rodés-Cabau J, Champagne J, Bernier M. Transcatheter closure of the left atrial appendage: Initial experience with the amplatzer cardiac plug device. Catheter Cardiovasc Interv. 2010;76:186–92.

    Article  PubMed  Google Scholar 

  75. Cruz-Gonzalez I. Martín Moreiras J, García E: Thrombus formation after left atrial appendage exclusion using an amplatzer cardiac plug device. Catheter Cardiovasc Interv. 2011;78:970–3.

    Article  PubMed  Google Scholar 

  76. Lam Y-Y, Yip GWK, Yu C-M, et al. Left atrial appendage closure with AMPLATZER cardiac plug for stroke prevention in atrial fibrillation: initial Asia-Pacific experience. Catheter Cardiovasc Interv Of J Soc Card Angiography Interv. 2012;79:794–800.

    Article  Google Scholar 

  77. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  78. Cheng Y, Conditt G, Yi G, et al. First In-Vivo Evaluation of the Ultrasept Left Atrial Appendage Closure Device. Miami: Presented at Transcatheter Cardiovascular Therapeutics (TCT) 2012; 2012.

    Google Scholar 

  79. Slater AD, Foley JL, Phillips L, Francischelli DE. Band occlusion of the atrial appendage. J Card Surg. 2010;25:156–60.

    Article  PubMed  Google Scholar 

  80. Sosa E. Scanavacca M, d'Avila A, Pilleggi F: A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996;7:531–6.

    Article  CAS  PubMed  Google Scholar 

  81. Lee RJ, Bartus K, Yakubov SJ. Catheter-based left atrial appendage (LAA) ligation for the prevention of embolic events arising from the LAA initial experience in a canine model. Circ Cardiovasc Interv. 2010;3:224–9.

    Article  PubMed  Google Scholar 

  82. Singh SM, Dukkipati SR. d'Avila A, et al.: Percutaneous left atrial appendage closure with an epicardial suture ligation approach: a prospective randomized pre-clinical feasibility study. Heart Rhythm. 2010;7:370–6.

    Article  PubMed  Google Scholar 

  83. Massumi A, Chelu MG, Nazeri A, et al. Initial experience with a novel percutaneous left atrial appendage exclusion device in patients with atrial fibrillation, increased stroke risk, and contraindications to anticoagulation. Am J Cardiol. 2013;111:869–73.

    Article  PubMed  Google Scholar 

  84. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14:1385–413. The most updated guidelines for the management of atrial fibrillation from the European Society of Cardiology include percutaneous left atrial appendage closure as a class IIb indication for patients with high stroke risk and contraindication to long-term OAC.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Joshua D. Moss has been a consultant for Carrot Medical and Biosense Webster. He has received grant support from Medtronic. He has received honoraria from Medtronic, St. Jude Medical, and Biotronik.

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.

Author information

Authors and Affiliations

  1. Section of Cardiology, Department of Internal Medicine, University of Chicago, 5758 S. Maryland Ave, MC 9024, Chicago, IL, 60637, USA

    Joshua D. Moss

Authors
  1. Joshua D. Moss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua D. Moss.

Additional information

This article is part of the Topical Collection on Echocardiography

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moss, J.D. Left Atrial Appendage Exclusion for Prevention of Stroke in Atrial Fibrillation: Review of Minimally Invasive Approaches. Curr Cardiol Rep 16, 448 (2014). https://doi.org/10.1007/s11886-013-0448-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-013-0448-1

Keywords

Search

Navigation