| Abstract [eng] |
Introduction. Atrial fibrillation is the most common clinically significant cardiac arrhythmia, affecting an increasing number of people. This condition increases the risk of stroke by 5 times compared to the general population and accounts for up to a quarter of all ischemic strokes. About 90 percent of all cardioembolic strokes due to non-valvular atrial fibrillation are caused by thrombi formed in the left atrial appendage. The conventional approach to preventing ischemic strokes has traditionally involved oral anticoagulants but there are patients for whom they are contraindicated. Faced with these challenges, there has been a need to explore alternative non-pharmacological strategies. One such alternative is left atrial appendage closure devices, which are increasingly being used in clinical practice as experience grows. The aim of this work is to review and provide comprehensive information based on scientific literature about left atrial appendage closure devices, their indications, key clinical trials conducted, the procedural aspects of implantation, post-implantation antithrombotic therapy, and potential complications. Discussion and Conclusions. Left atrial appendage closure devices should be considered for patients for whom long-term oral anticoagulant therapy is contraindicated due to a high risk of significant bleeding or severe intolerance to anticoagulants. Currently, there are several closure devices on the market, especially in Europe, but the most widely used and extensively studied is the WATCHMAN device. Before considering implantation of a left atrial appendage closure device, candidates should undergo transesophageal echocardiography evaluation. In the absence of contraindications, the procedure is performed using either general endotracheal or local anesthesia. After 6 to 24 weeks following the procedure, it is necessary to repeat transesophageal echocardiography to assess the effectiveness of atrial appendage closure. Post-implantation, antithrombotic therapy is necessary, but the precise regimen and duration of treatment are mostly based on individual physician discretion. Although significant complications may occur after the implantation procedure, they are not common, and their frequency decreases with increasing operator experience. |
