Includes References and Index n

Left atrial appendage (LAA) closure is a rapidly emerging field in stroke prevention
for patients with atrial fibrillation. The first surgical procedure to remove the LAA
was performed in 1949, and the first percutaneous LAA closure was performed in
humans in 2001 with the PLAATO device. Several percutaneous and surgical
devices are now approved worldwide, and many more are in clinical development
and being evaluated in research trials. The current most widely used endovascular
devices worldwide are the WATCHMAN and Amplatzer Cardiac Plug (Amulet,
second generation) devices, which received CE Mark in 2005 and 2008, respectively. In addition, the WATCHMAN device recently received FDA approval in
March 2015 in the United States for patients at high risk of stroke who are suitable
for warfarin, and who have appropriate rationale for non-pharmacologic stroke
prevention alternative.
Results from several early preclinical and clinical research studies have ascertained the safety and efficacy of percutaneous LAA closure in stroke prevention,
including randomized controlled trials with the WATCHMAN device that showed
superiority in comparison to warfarin. Further preclinical and clinical research trials
and data are rapidly accumulating with this and other devices. Although these initial
randomized trials evaluated patients who are candidates for oral anticoagulation, the
current predominant real-world application for this procedure is mostly restricted to
patients who have contraindications to anticoagulation. Even this restricted indication has substantial implications on application of this procedure, since over 40 %
of patients with atrial fibrillation who have guideline indications for anticoagulation
are not on anticoagulation because of contraindications, intolerance, or were felt to
be poor candidates for anticoagulation. Broader application to patients without
these restrictions is anticipated as this procedure and technology matures, and further clinical trial data becomes available. Thus, LAA closure has evolved to become
an important alternative to oral anticoagulation in patients with atrial fibrillation and
is expected to remain a dominant technology for stroke prevention with this prevalent arrhythmia. LAA closure is a technically challenging procedure with both percutaneous and
surgical approaches. Advancement in technology and procedural techniques has
improved the safety and efficacy of LAA closure. Detailed knowledge of the rationale, anatomy, and technical approach of this procedure guides operators in patient
selection and facilitates procedural success. Our textbook provides a comprehensive
overview of the current state-of-the-art LAA closure, covering the background epidemiology of atrial fibrillation and stroke, the LAA anatomy, imaging of LAA, and
the LAA closure procedure. Modern devices, characteristics, procedural techniques,
complications, and contemporary study results on LAA closure are reviewed in
detail in dedicated focused chapters according to the different devices. Novel
devices in development, procedural complications, post-procedural antithrombotic
therapy, and long-term post-closure surveillance are also reviewed.
This textbook is targeted to all medical staffs involved with LAA closure procedures, including those learning to perform the procedure, those who provide
imaging guidance for the procedure, and those managing patients during and after
the procedure. Thus, interventional cardiologists, electrophysiologists, echocardiographers, radiographers, nurse practitioners, nurses, fellows, and residents
should find this textbook to be a useful resource to guide management of patients
prior to, during, and following LAA closure.