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      EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion

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      EuroIntervention
      Europa Digital & Publishing

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          Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation.

          Left atrial appendage obliteration was historically ineffective for the prevention of postoperative stroke in patients with rheumatic atrial fibrillation who underwent operative mitral valvotomy. It is, however, a routine part of modern "curative" operations for nonrheumatic atrial fibrillation, such as the maze and corridor procedures. To assess the potential of left atrial appendage obliteration to prevent stroke in nonrheumatic atrial fibrillation patients, we reviewed previous reports that identified the etiology of atrial fibrillation and evaluated the presence and location of left atrial thrombus by transesophageal echocardiography, autopsy, or operation. Twenty-three separate studies were reviewed, and 446 of 3,504 (13%) rheumatic atrial fibrillation patients, and 222 of 1,288 (17%) nonrheumatic atrial fibrillation patients had a documented left atrial thrombus. Anticoagulation status was variable and not controlled for. Thrombi were localized to, or were present in the left atrial appendage and extended into the left atrial cavity in 254 of 446 (57%) of patients with rheumatic atrial fibrillation. In contrast, 201 of 222 (91%) of nonrheumatic atrial fibrillation-related left atrial thrombi were isolated to, or originated in the left atrial appendage (p < 0.0001). These data suggest that left atrial appendage obliteration is a strategy of potential value for stroke prophylaxis in nonrheumatic atrial fibrillation.
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            Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited.

            Atrial fibrillation is the most common sustained cardiac arrhythmia, which is associated with a high risk of stroke and thromboembolism. Increasing evidence suggests that the thrombogenic tendency in atrial fibrillation is related to several underlying pathophysiological mechanisms. Abnormal changes in flow are evident by stasis in the left atrium, and seen as spontaneous echocontrast. Abnormal changes in vessel walls-essentially, anatomical and structural defects-include progressive atrial dilatation, endocardial denudation, and oedematous or fibroelastic infiltration of the extracellular matrix. Additionally, abnormal changes in blood constituents are well described, and include haemostatic and platelet activation, as well as inflammation and growth factor changes. These changes result in the fulfilment of Virchow's triad for thrombogenesis, and accord with a prothrombotic or hypercoagulable state in this arrhythmia. In this Review, we present an overview of the established and purported mechanisms for thrombogenesis in atrial fibrillation.
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              Increasing prevalence of atrial fibrillation and flutter in the United States.

              The prevalence data for atrial fibrillation (AF) are dated. The present retrospective study estimated the current and projected prevalence of AF and atrial flutter (AFL) in the United States using a large national database. Claims data drawn from July 2004 to December 2005 from the MarketScan research databases from Thomson Reuters were used to identify patients aged >or=20 years with nontransient AF and/or AFL and age- and gender-matched controls without these conditions. Of the 21,648,681 patients in the databases, 242,903 (1.12%) had nontransient AF and/or AFL (222,605 AF only, 5,376 AFL only, and 14,922 AF and AFL). Patients with AF only, AFL only, and AF and AFL had a greater (p <0.001) prevalence of co-morbidities, including hypertension (62.0%, 61.3%, and 57.0%, respectively) and coronary artery disease (43.0%, 44.7%, and 44.5%, respectively), than matched controls (45.1% hypertension and 19.4% coronary artery disease). Applying the US Census Bureau population estimates to the prevalence rates for AF and/or AFL in the databases, it was estimated that 3.03 million persons in the United States had AF only, 0.07 million had AFL only, and 0.19 million had AF and AFL in 2005. The projected prevalence for 2050 was 7.56 million for AF only, 0.15 million for AFL only, and 0.44 million for AF and AFL. In conclusion, the current prevalence of AF and AFL is high and is projected to increase considerably by 2050. The current and projected increases in the prevalence of AF are greater than predicted by a previous sentinel study and might reflect more than the aging of the population.
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                Author and article information

                Journal
                EuroIntervention
                EuroIntervention
                Europa Digital & Publishing
                1774-024X
                January 2015
                January 2015
                : 10
                : 9
                : 1109-1125
                Article
                10.4244/EIJY14M09_18
                25169595
                47240af1-62ee-4c28-b2be-a42d4d9e5511
                © 2015
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