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Left atrial appendage occlusion

Senthil Thambidorai

Left Atrial Appendage: Complex structure with variable shape and size, Effective contractions during normal sinus rhythm. Ineffective contractions during AF, Morphologies: Cactus, Chicken Wing, Cauliflower, Windsock. Why LAAO? Frequent source of systemic emboli, 92% of LA thrombi are localized in LAA, Occlusion decreases the risk of systemic embolization, Alternative to OAC in those with contraindication or high bleeding risk. Types of Occluders: Watchmen, PLAATO, ACP, WaveCrest, Potential Indications. Secondary stroke prevention: Failed OAC: ischemic stroke in patients using OAC, Severe bleeding occurred during OAC treatment, Alternative to OAC in patients with high bleeding risk, On top of OAC to further decrease risk of stroke recurrence. Primary stroke prevention: High bleeding risk AND high risk of stroke, Published Evidence, PROTECT AF trial, PREVAIL trial, LAA Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: Meta-Analysis., LAAO for stroke prevention in AF: a systematic review and network meta-analysis of randomized controlled trials, PINNACLE FLX. Perspective Trials, OPTION Trial, CHAMPION-AF, CATALYST Trial.