When to Refer Patients for Left Atrial Appendage Closure

Abstract

Referring patients with nonvalvular atrial fibrillation (NVAF) for left atrial appendage closure (LAAC) device should be based on bleeding risks, poor anticoagulation compliance, and patient goals. Patient selection should consider overall prognosis and risk of implant procedure. We detail specific clinical scenarios where LAAC could be considered, based on FDA-approved indications. The indications for LAAC are different in Europe. High-risk scenarios in which LAA occlusion may be preferred alone, or in addition to oral anticoagulation use, are reviewed. Ongoing clinical trials and newer device designs will help change the appropriate post-implant drug regimen which will affect patient and device selection.

Keywords: Anticoagulation; Atrial fibrillation; HAS-BLED; Hemorrhagic stroke; Left atrial appendage (LAA); Major bleeding; Nonvalvular atrial fibrillation.