State-of-the-Art Review Examines LAAO as Therapy For Stroke Prevention in Patients With AFib

The utility of left atrial appendage occlusion (LAAO) as a therapy for stroke prevention in patients with nonvalvular atrial fibrillation (AFib) is the focus of a State-of-the-Art Review published Jan. 8 in JACC: Clinical Electrophysiology.

Jalaj Garg, MBBS, FACC, et al., discuss the procedure’s journey to becoming a mainstream approach for stroke prevention, advancements in LAAO devices over the past two decades, and domains requiring additional scientific inquiry. The authors describe the LAA as an “important therapeutic target” in treating patients with AFib, as the LAA is “the most common site for thrombus formation and an important source of non-pulmonary vein triggers.” They outline the anatomy, physiology and clinical relevance of the LAA along with the evolution of LAA exclusion techniques and devices overtime.

Acknowledging the major advancements in LAAO device technology and clinical benefits, the authors note the ACC, American Heart Association and Heart Rhythm Society have “updated recommendations to Class 2a in patients with moderate to high risk for stroke or contraindications to long-term [oral anticoagulation (OAC)], with weak recommendations (Class 2b) in patients with moderate to high risk for stroke or reasonable to continue long-term OAC.”

The authors explore a range of topics where unanswered questions still remain pertaining to LAAO, including optimal patient selection, preferred procedural approach/device, antithrombotic regimen, and management of periprocedural and postprocedure complications.

They also highlight the promise of future devices, such as coated devices and novel closure methods, introduced with the goal of overcoming current limitations such as device-related thrombosis.

“As the LAAO device market continues to evolve, reducing the slope of the operator learning curve, reducing the efficiency of closure, and improving the procedure’s safety profile continue to be of utmost importance,” write the authors.