Moras Errol, Gandhi Kruti, Yakkali Shreyas, Frishman William H, Aronow Wilbert S
From the Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, NY.
Cardiol Rev. 2024 Jul 30. doi: 10.1097/CRD.0000000000000757.
Nonvalvular atrial fibrillation (AF) is a common rhythm disorder of middle-aged to older adults that can cause ischemic strokes and systemic embolism. Stroke prevention is a crucial aspect of management, considering the increasing AF population and the associated morbidity and mortality. The left atrial appendage (LAA) has been identified as a predominant source of AF-associated thrombus and stroke, with at least 90% of the thrombi originating from this anatomical structure. Lifelong use of oral anticoagulants reduces the risk of these ischemic events but increases the risk of major and clinically relevant hemorrhages. In addition, these medications also require strict compliance for efficacy and have high failure rates in higher-risk patients. LAA occlusion (LAAO) has emerged as an alternative strategy for stroke prevention with encompassing various percutaneous and surgical techniques. Randomized controlled trials evaluating this intervention have shown promising results in stroke reduction replacing anticoagulation therapy. In this review, we aim to provide a comprehensive overview on the anatomy of the LAA and its role in thrombus formation, the emergence of various LAAO techniques and devices, and provide evidence on the role of LAAO in the reduction of stroke risk among patients with nonvalvular AF.
非瓣膜性心房颤动（AF）是中老年人常见的节律紊乱，可导致缺血性中风和全身栓塞。鉴于房颤患者数量不断增加以及相关的发病率和死亡率，预防中风是管理的关键方面。左心耳（LAA）已被确定为房颤相关血栓和中风的主要来源，至少90%的血栓起源于这个解剖结构。长期使用口服抗凝剂可降低这些缺血性事件的风险，但会增加严重和具有临床相关性出血的风险。此外，这些药物还需要严格遵守用药规定才能有效，并且在高危患者中的失败率很高。左心耳封堵术（LAAO）已成为一种预防中风的替代策略，包括各种经皮和外科技术。评估这种干预措施的随机对照试验在减少中风方面显示出了令人鼓舞的结果，可替代抗凝治疗。在本综述中，我们旨在全面概述左心耳的解剖结构及其在血栓形成中的作用、各种左心耳封堵技术和装置的出现，并提供左心耳封堵术在降低非瓣膜性房颤患者中风风险方面作用的证据。
