Percutaneous Left Atrial Appendage Exclusion Therapy: Who, Why and How?

Purpose: Patients with atrial fibrillation are at an increased risk of having a cardio embolic stroke. Stroke is a leading cause of death and disability worldwide. Current guidelines recommend an antithrombotic regimen to prevent thromboembolism in medium and high risk patients with AF. However, a substantial number of patients are not eligible for this therapy. The exclusion of the left atrial appendage (LAA) from circulation seems to be an alternative strategy for stroke prevention in AF. This review focuses on the different strategies for LAA exclusion with special focus on the WATCHMAN Device. Two devices are currently in use for percutaneous transcatheter occlusion of the LAA: the WATCHMAN® - device and the AMPLATZER® -septal occluder. For both devices safety and feasibility data are available. Additionally about 200 patients received a PLAATO® -device- which is currently no more available due to economic reasons. Patients treated with the PLAATO device were at high risk for thromboembolic stroke and had contraindications for oral anticoagulation therapy. The Watchman® -device was implanted in 800 patients that were eligible for long-term anticoagulation therapy with a moderate risk for thromboembolic stroke due to non-valvular AF. Summary: For both devices, a reduction in the risk of stroke was documented and device implantation was shown to be safe and feasible. Provided the ongoing trials show noninferiority to oral anticoagulation, another therapeutic option will become available to prevent ischemic strokes.