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Evolution of left atrial appendage occlusion therapy - where are we now?

ESC Congress News 2018 - Munich, Germany

The left atrial appendage (LAA) is the main source of thromboembolism in patients with nonvalvular atrial fibrillation (AF). Percutaneous LAA occlusion therapy has emerged as an alternative to oral anticoagulants in selected patients, with many important advances in the decade since the first randomised controlled trial was conducted.

Atrial Fibrillation
Interventional Cardiology
Venous Thromboembolism


Ted-Feldman2016-congress-news.jpgProcedural and long-term follow-up data are now available for the WATCHMAN device, with several large registry reports providing outcomes data regarding use of several types of devices in a real-world setting. LAA occluders have themselves evolved and several devices are in the clinical investigational pipeline.

With a greater understanding of LAA size and morphology and how this affects stroke risk and procedure success, the most appropriate candidates and the most appropriate closure strategies are being better defined. Regarding imaging advances, it has been recognised that cardiac computed tomography (CT) can play an important role in defining the patient’s LAA anatomy before the procedure as either an alternative or a supplement to transoesophageal echocardiography (TOE). In addition, improvements in intracardiac echocardiography (ICE) may allow guidance during the procedure without the need for general anaesthesia and TOE imaging in selected cases.

“Not only the LAA occlusion technologies but also the techniques have improved in recent years,” says Professor Feldman.

The accrual of real-world data from registries has allowed greater scrutiny of the incidence of periprocedural complications, such as device-related thrombus. As a result, a new wave of trials to study post procedure anticoagulation approaches is underway. These trials highlight the need for continued evolution of LAA occlusion therapies, with optimisation of pre-/intra-/post-procedural imaging, patient selection and postprocedural anti-platelet and anticoagulation therapy to achieve more favourable outcomes.

Don’t miss!
Live in the Box: Left Atrial Appendage Occlusion
Today, 11.00 – 12.30 in Centre
Stage – The Hub

 

Click here to read other scientific highlights in the ESC Congress news.

Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme