Percutaneous left atrial appendage closure is a new approach to prevent thromboembolic events in patients with atrial fibrillation who are not eligible for oral anticoagulation (OAC).
Atrial fibrillation is one of the most common heart rhythm disorders, of which the most frequently occurring complication is thromboembolism and in particular ischaemic stroke. It is believed that in more than 90% of all cases the thrombus originates from the left atrial appendage. Currently, the gold standard in the antithrombotic therapy of atrial fibrillation is OAC with vitamin-K antagonists. The percutaneous closure of the left atrial appendage is a new non-pharmacological approach aiming at eliminating the left atrial appendage from systemic circulation in order to prevent thromboembolic events, such as ischaemic stroke. The aim of our systematic review is to compare the efficacy and safety of percutaneous left atrial appendage (LAA) closure to prevent thromboembolic events with that of OAC with vitamin-K antagonists.
In a comprehensive literature search we identified seven studies overall that met our pre-specified inclusion criteria. Of these, one was a randomised controlled trial and the remaining six were case-series. The results indicate that percutaneous left atrial appendage closure is not inferior to OAC in terms of a composite endpoint of efficacy. However, it appears to be less safe, mainly due to procedure- and device-related complications.
Percutaneous left atrial appendage closure could be an appropriate alternative for patients who are not eligible for OAC with vitamin-K antagonists. However, in the studies identified in our systematic review this population has not been investigated. Therefore, no conclusion can be drawn on the efficacy and safety of percutaneous left atrial appendage closure in this particular group of patients.