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Brain & Heart A left atrial appendage occlusion review

alternatives to continued anticoagulation. In certain cases Acknowledgments
of severe PDLs, vascular plugs and occluders have also been
offered as a treatment strategy, with one study showing None.
an overall 94% reduction in leak size using Amplatzer Funding
Vascular Plugs and Duct Occluders. 67,68
None.
A study of patients followed for 1 year after Watchman
FLX implantation revealed that up to 10% of patients had Conflict of interest
a leakage of up to 5 mm, and this resulted in an increased
risk for thromboembolic events. 18,69 Device-related Chunguang Chen is the Guest Editor of this special issue,
thrombosis is also a complication of percutaneous LAAC but was not in any way involved in the editorial and
device placement and has been reported to contribute peer-review process conducted for this paper, directly or
to up to a 16% incidence in thromboembolic events, 70,71 indirectly. Separately, other authors declared that they
with one meta-analysis of >10,000 patients reporting an have no known competing financial interests or personal
approximate incidence of 3.8%. Several predictors of relationships that could have influenced the work reported
72
device-related thrombosis have been identified in the in this paper.
literature; one study found five independent predictors Author contributions
of device-related thrombosis (hypercoagulopathy, renal
insufficiency, permanent atrial fibrillation, deep device Conceptualization: Chunguang Chen, Daniel S. Ice
implantation, and pericardial effusion) using a logistic Writing – original draft: Mihir V. Odak, Chamaka Kalutota,
regression model for risk stratification. 73 Steven Douedi, Zachary Estep, Andrew Josephson,
Gin Chang
While anticoagulation is a reasonable option in Writing – review & editing: Mihir V. Odak, Chamaka Kalutota
individuals at a high risk of device-related thrombosis
stemming from peridevice placement, administration Ethics approval and consent to participate
of anticoagulation increases the risk of life-threatening
bleeding in individuals who presumably already have a Not applicable.
contraindication to anticoagulation, necessitating LAAC Consent for publication
therapy. Further long-term data on intraprocedural
adjustments are warranted to identify specific factors that Not applicable.
predispose to device-related thrombosis.
Availability of data
10. Conclusion Not applicable.
Atrial fibrillation is a highly prevalent condition and
represents a significant economic burden to the United References
States health-care system. The incidence of atrial fibrillation 1. Lippi G, Sanchis-Gomar F, Cervellin G. Global
is likely to rise in the coming years, therefore warranting epidemiology of atrial fibrillation: An increasing epidemic
more intensive research and development on atrial and public health challenge [published correction appears
fibrillation therapy. There have indeed been advancements in Int J Stroke. 2020 Jan 28;1747493020905964]. Int J Stroke.
71
in pharmacological therapy and protection in individuals 2021;16(2):217-221.
with atrial fibrillation and a high thromboembolic risk doi: 10.1177/1747493019897870
through novel oral anticoagulation medications, but these 2. Kong B, Liu Y, Huang H, Jiang H, Huang C. Left atrial
medications can also present a significant risk to patients appendage closure for thromboembolism prevention in
at high risk of bleeding events. In such individuals, patients with atrial fibrillation: Advances and perspectives.
percutaneous LAAC strategies are a safe and efficacious J Thorac Dis. 2015;7(2):199-203.
alternative to anticoagulation. Evident in the newer doi: 10.3978/j.issn.2072-1439.2015.01.20
generations of devices and technologies introduced, there
have been improvements in the safety and efficacy profiles 3. Arora Y, Jozsa F, Soos MP. Anatomy, thorax, heart left atrial
appendage. In: StatPearls. Treasure Island, FL: StatPearls
of this procedure, which are expected to enhance further. Publishing; 2024.
Further data and investigations will be critical to ascertain
short- and long-term benefits of these devices, identify 4. Moss AJ. Atrial electrical activity and atrial fibrillation. Ann
cohorts that benefit the most, and evaluate the device’s Noninvasive Electrocardiol. 2006;11(3):201-202.
impact on morbidity associated with atrial fibrillation. 5. Parsons C, Patel SI, Cha S, et al. CHA DS -VASc Score:
2 2

Volume 3 Issue 3 (2025) 8 doi: 10.36922/bh.4016