Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician. An International Consensus Paper.

Feb 05, 2024

Experts: Tatjana Potpara, Marek Grygier, Karl Georg Haeusler, Jens Erik Nielsen-Kudsk, Sergio Berti, Simonetta Genovesi, Eloi Marijon, Serge Boveda, Apostolos Tzikas, Giuseppe Boriani, Lucas V A Boersma, Claudio Tondo, Tom De Potter, Gregory Y H Lip, Renate B Schnabel, Rupert Bauersachs, Marco Senzolo, Carlo Basile, Stefano Bianchi, Pavel Osmancik, Boris Schmidt, Ulf Landmesser, Wolfram Doehner, Gerhard Hindricks, Jan Kovac, A John Camm

A significant proportion of patients who suffer from atrial fibrillation and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well-known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with atrial fibrillation. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

Author

admin

View all posts

ABOUT THE EXPERTS

Tatjana Potpara, Marek Grygier, Karl Georg Haeusler, Jens Erik Nielsen-Kudsk, Sergio Berti, Simonetta Genovesi, Eloi Marijon, Serge Boveda, Apostolos Tzikas, Giuseppe Boriani, Lucas V A Boersma, Claudio Tondo, Tom De Potter, Gregory Y H Lip, Renate B Schnabel, Rupert Bauersachs, Marco Senzolo, Carlo Basile, Stefano Bianchi, Pavel Osmancik, Boris Schmidt, Ulf Landmesser, Wolfram Doehner, Gerhard Hindricks, Jan Kovac, A John Camm

Tatjana Potpara

Medical Faculty, University of Belgrade, Serbia.

University Clinical Centre of Serbia, Belgrade, Serbia.

Marek Grygier

Chair and 1st Department of Cardiology, Poznan University School of Medical Sciences, Poznan, Poland.

Karl Georg Haeusler

Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany.

Jens Erik Nielsen-Kudsk

Aarhus University Hospital, Aarhus, Denmark.

Sergio Berti

Ospedale del Cuore, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy.

Simonetta Genovesi

School of Medicine and Surgery, University of Milano-Bicocca, Nephrology Clinic, Monza, Italy and Istituto Auxologico Italiano, IRCCS, Milan, Italy.

Eloi Marijon

Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France.

Serge Boveda

Cardiology, Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Brussels University VUB, Brussels, Belgium.

Apostolos Tzikas

Ippokrateio Hospital of Thessaloniki, Aristotle University of Thessaloniki and European Interbalkan Medical Centre, Thessaloniki, Greece.

Giuseppe Boriani

Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.

Lucas V A Boersma

Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Centers, Netherlands.

Claudio Tondo

Centro Cardiologico Monzino, IRCCS, Department of Clinical Electrophysiology & Cardiac Pacing, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

Tom De Potter

Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.

Gregory Y H Lip

Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Renate B Schnabel

Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.

Rupert Bauersachs

Cardioangiology Center Bethanien CCB, Frankfurt, Germany Center for Vascular Research, Munich, Germany.

Marco Senzolo

Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.

Carlo Basile

Scientific director of the Division of Nephrology, Miull General Hospital, Acquaviva delle Fonti, Italy and chair of the EuDial Working Group of the European Renal Association.

Stefano Bianchi

President Italian Society of Nephrology, Nephrology and Dialysis Unit, ASL Toscana NordOvest, Livorno, Italy.

Pavel Osmancik

Dept. of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.

Boris Schmidt

Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, W.-Epstein-Str. 4; 60431 Frankfurt, Germany.

Ulf Landmesser

Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum Charité Charité University Medicine Berlin; Friede Springer Cardiovascular Prevention Center @Charité.

Wolfram Doehner

Berlin Institute of Health-Center for Regenerative Therapies, Berlin, Germany, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany.

German Centre for Cardiovascular Research (DZHK)- partner site Berlin Charité Universitätsmedizin Berlin, Germany.

Gerhard Hindricks

German Heart Center Charite, Campus Mitte, Berlin, Germany.

Jan Kovac

Leicester NIHR BRU, University of Leicester, Glenfield Hospital, Leicester.

A John Camm

St. George’s University of London, London, United Kingdom.