TY - JOUR
T1 - Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician. An International Consensus Paper
AU - Potpara, Tatjana
AU - Grygier, Marek
AU - Haeusler, Karl Georg
AU - Nielsen-Kudsk, Jens Erik
AU - Berti, Sergio
AU - Genovesi, Simonetta
AU - Marijon, Eloi
AU - Boveda, Serge
AU - Tzikas, Apostolos
AU - Boriani, Giuseppe
AU - Boersma, Lucas V. A.
AU - Tondo, Claudio
AU - De Potter, Tom
AU - Lip, Gregory Y. H.
AU - Schnabel, Renate B.
AU - Bauersachs, Rupert
AU - Senzolo, Marco
AU - Basile, Carlo
AU - Bianchi, Stefano
AU - Osmancik, Pavel
AU - Schmidt, Boris
AU - Landmesser, Ulf
AU - Doehner, Wolfram
AU - Hindricks, Gerhard
AU - Kovac, Jan
AU - Camm, A. John
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024/4
Y1 - 2024/4
N2 - A significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years, left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with AF. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.
AB - A significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years, left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with AF. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.
KW - Adult
KW - Anticoagulants/adverse effects
KW - Atrial Appendage/surgery
KW - Atrial Fibrillation/complications
KW - Consensus
KW - Hemorrhage/chemically induced
KW - Humans
KW - Left Atrial Appendage Closure
KW - Physicians
KW - Stroke/prevention & control
KW - Thromboembolism/etiology
KW - Treatment Outcome
KW - Vitamin K
KW - Stroke
KW - Atrial fibrillation
KW - Left atrial appendage closure
KW - Left atrial appendage occlusion
KW - Anticoagulation
KW - Bleeding
KW - Prevention
UR - http://www.scopus.com/inward/record.url?scp=85190694084&partnerID=8YFLogxK
U2 - 10.1093/europace/euae035
DO - 10.1093/europace/euae035
M3 - Journal article
C2 - 38291925
SN - 1099-5129
VL - 26
JO - Europace
JF - Europace
IS - 4
M1 - euae035
ER -