Left Atrial Appendage Occlusion as a Modern Alternative to Anticoagulation
An ideal paradigm of targeted device-based therapy to replace systemic anticoagulation
to prevent stroke in patients with nonvalvular atrial fibrillation has resulted in immense interest and innovation to cut, clip, chop, close, isolate, occlude and obliterate the enigmatic left atrial appendage (LAA). LAA occlusion (LAAO) has been demonstrated as an alternative to anticoagulation for stroke risk reduction in the setting of non-valvular atrial fibrillation [1]. While real-world data has shown low procedural risks [2], there has been a robust effort to improve the efficacy, efficiency, and safety of LAAO. This has led to an interest in enhanced procedural planning and research into the optimal anti-thrombotic regimen post-implantation. A significant contributor to the mystery and complexity of LAAO is the anatomical considerations of the LAA. It is a widely heterogeneous structure with a diverse range of morphologies, sizes, and the potential for multiple lobes [3]. Beyond its heterogeneous nature, the LAA is a thin-walled structure that is prone to perforation and procedural complications.