Left atrial appendage occlusion (old)

Summary

Atrial fibrillation is a common condition with a lifetime incidence approaching 25% and an ever-increasing prevalence in an aging society. The most important consequences of atrial fibrillation are embolic cerebrovascular accidents. While anticoagulation strategies result in significant reductions in embolic events, they are not without limitations and complications. In patients with atrial fibrillation, the vast majority of thrombus originates in the left atrial appendage. Exclusion of the left atrium, by either surgical or percutaneous methods, potentially minimizes the risk of embolic cerebrovascular accidents and may eliminate the need for chronic anti-coagulation. This chapter reviews the underlying concepts involving atrial fibrillation, outlines anticoagulation strategies for thromboembolism prevention, and describes the current state and future directions of left atrial appendage occlusion.

Introduction

Atrial fibrillation is an extremely common condition with a prevalence of approximately 0.4% and a strong association with age and male sex. The age-adjusted incidence approaches 5% per year in patients greater than 80 years of age, and prevalence in this population is approximately 9%. The lifetime risk of developing atrial fibrillation is approximately 1 in 4.1