Publication Date
11-2-2021
Journal
Journal of the American Heart Association
DOI
10.1161/JAHA.121.022274
PMID
34668395
PMCID
PMC8751840
PubMedCentral® Posted Date
10-20-2021
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Anticoagulants, Atrial Appendage, Atrial Fibrillation, Hemorrhage, Humans, Stroke, atrial fibrillation, left atrial appendage, left atrial appendage occlusion, stroke
Abstract
The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke prevention in nonvalvular atrial fibrillation. A thorough review of the history of surgical and percutaneous left atrial appendage occlusion devices, recent trials, and US Food and Drug Administration milestones of current left atrial appendage occlusion devices are discussed.