Left Atrial Appendage Occlusion as a Modern Alternative to
Anticoagulation
An ideal paradigm of targeted device-based therapy to replace systemic
anticoagulation
to prevent stroke in patients with nonvalvular atrial fibrillation has
resulted in immense interest and innovation to cut, clip, chop, close,
isolate, occlude and obliterate the enigmatic left atrial appendage
(LAA). LAA occlusion (LAAO) has been demonstrated as an alternative to
anticoagulation for stroke risk reduction in the setting of non-valvular
atrial fibrillation [1]. While real-world data has shown low
procedural risks [2], there has been a robust effort to improve the
efficacy, efficiency, and safety of LAAO. This has led to an interest in
enhanced procedural planning and research into the optimal
anti-thrombotic regimen post-implantation. A significant contributor to
the mystery and complexity of LAAO is the anatomical considerations of
the LAA. It is a widely heterogeneous structure with a diverse range of
morphologies, sizes, and the potential for multiple lobes [3].
Beyond its heterogeneous nature, the LAA is a thin-walled structure that
is prone to perforation and procedural complications.