Highlights
- •Atrial fibrillation (AF) causes cardiogenic embolism which is the critical complication.
- •Oral anticoagulation (OAC) plays a central role in reducing stroke risk in AF patients.
- •There is a subset of patients who cannot tolerate OAC due to high-bleeding risk.
- •One of the promising non-pharmacological therapies is left atrial appendage closure (LAAC).
- •LAAC may be an alternative therapy to avoid stroke for AF patients with high bleeding risk by OAC.
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice
and its prevalence increases with age. AF causes palpitations, heart failure, and
cardiogenic embolism. Of them, the most critical and fatal complication is a cardio-embolic
event. Oral anticoagulation plays a central role in reducing stroke risk in AF patients.
Recently, when oral anticoagulation is considered in patients with non-valvular AF
who are eligible for direct oral coagulations, they are preferred to vitamin K antagonist
based on accumulating evidence. Although many patients can tolerate oral anticoagulation,
there is a subset of patients who cannot tolerate long-term oral anticoagulation.
Such a subset has a higher bleeding risk as indicated by the HAS-BLED score under
oral anticoagulation. This subset of patients requires effective and safe non-pharmacological
alternative therapies for stroke prevention. One of the promising non-pharmacological
therapies is left atrial appendage closure. Three randomized controlled trials demonstrated
non-inferiority of percutaneous left atrial appendage closure using WATCHMAN family
to oral anticoagulation (Boston Scientific, Marlborough, MA, USA). WATCHMAN FLX, which
was innovated following WATCHMAN 2.5, was associated with fewer safety events and
a higher success rate of effective appendage closure. Nevertheless, several unsolved
issues remain, including device-related thrombosis, post-treatment antithrombotic
therapy, and peri-device leakage. Left atrial appendage closure for patients with
non-valvular AF may be an alternative therapy to avoid cardiac embolism for high bleeding
risk patients with contraindications to long-term oral anticoagulation therapy.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 24, 2022
Accepted:
October 25,
2022
Received:
October 25,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
