Percutaneous occlusion of the left atrial appendage. Alternative to oral anticoagulation in patients with atrial fibrillation

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia affecting up to 10-15% of the population aged over 80 years. Oral anticoagulation (OAC) is necessary in the majority of AF patients for prevention of left atrial thrombus formation and thromboembolism of cardiac origin which are responsible for approximately 20-30% of strokes. Thus, a considerable risk reduction can be achieved; however, OAC is associated with an increased bleeding risk. Many AF patients are not treated by OAC due to a history of bleeding complications or an increased bleeding risk. As over 90% of thrombi in non-valvular AF develop in the left atrial appendage (LAA) percutaneous occlusion of the LAA is an alternative concept for the prevention of cardiovascular thromboembolism in AF patients. Currently, the most widely used occlusion devices are the WATCHMAN device and the Amplatzer Cardiac Plug. Available data records indicate that closure of the LAA is as equally effective as OAC. Moreover, with increasing experience percutaneous occlusion of the LAA can be performed with low complication rates. Therefore, according to the current guidelines of the European Society of Cardiology (ESC) this intervention is recommended as an alternative therapy, especially in patients with a high stroke risk and contraindications for OAC.