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Thromb Haemost
DOI: 10.1055/a-2469-4896
Review Article

An International Consensus Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician: Executive Summary

Tatjana Potpara 
1   Medical Faculty, University of Belgrade, University Clinical Centre of Serbia, Belgrade, Serbia
,
Marek Grygier 
2   1st Department of Cardiology, Poznan University School of Medical Sciences, Poznan, Poland
,
Karl Georg Haeusler 
3   Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
,
Jens Erik Nielsen-Kudsk 
4   Aarhus University Hospital, Aarhus, Denmark
,
Sergio Berti 
5   Ospedale del Cuore, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy
,
Simonetta Genovesi 
6   School of Medicine and Surgery, Nephrology Clinic, Monza, Italy and Istituto Auxologico Italiano, University of Milano-Bicocca, IRCCS, Milan, Italy
,
Eloi Marijon 
7   Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
,
Serge Boveda 
8   Cardiology, Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
9   Brussels University VUB, Brussels, Belgium
,
Apostolos Tzikas 
10   European Interbalkan Medical Centre, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece
,
Giuseppe Boriani 
11   Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
,
Lucas V. A. Boersma 
12   Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Centers, The Netherlands
,
Claudio Tondo 
13   Department of Clinical Electrophysiology and Cardiac Pacing, Department of Biomedical, Surgical and Dental Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
,
Tom De Potter 
14   Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
,
Gregory Y. H. Lip 
15   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
16   Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
,
Renate B. Schnabel 
17   Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
18   German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
,
Rupert Bauersachs 
19   Cardioangiology Center Bethanien CCB, Frankfurt, Germany; Center for Vascular Research, Munich, Germany
,
Marco Senzolo 
20   Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
,
Carlo Basile 
21   Division of Nephrology, EuDial Working Group of the European Renal Association, Miull General Hospital, Acquaviva delle Fonti, Italy
,
Stefano Bianchi 
22   Nephrology and Dialysis Unit, Italian Society of Nephrology, ASL Toscana NordOvest, Livorno, Italy
,
Pavel Osmancik 
23   Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
,
Boris Schmidt 
24   Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt, Germany
,
Ulf Landmesser 
25   Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité University Medicine Berlin, Friede Springer Cardiovascular Prevention Center @Charité, Berlin, Germany
,
Wolfram Doehner 
26   Berlin Institute of Health-Center for Regenerative Therapies, Berlin, Germany, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
27   German Centre for Cardiovascular Research (DZHK)- Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
,
Gerhard Hindricks 
28   German Heart Center Charite, Campus Mitte, Berlin, Germany
,
Jan Kovac 
29   Leicester NIHR BRU, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
,
A. John Camm 
30   St. George's University of London, London, United Kingdom
› Author Affiliations
Funding This project was investigator-proposed and conducted and was supported by an educational grant from Boston Scientific for the payment of Article Processing Charges. The sponsor was not involved in the construction of the manuscript.
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Abstract

Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.

Keywords

anticoagulation - atrial fibrillation - bleeding - left atrial appendage closure - left atrial appendage occlusion - stroke - prevention

Supplementary Material



Publication History

Received: 12 November 2024

Accepted: 14 November 2024

Article published online:
10 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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