• Der Internist · Feb 2022

    Review

    [Atrial fibrillation and the limits of oral anticoagulation: for whom are left atrial appendage occluders suitable?]

    • Sebastian Feickert, Niels Christian Ewertsen, Giuseppe D'Ancona, Alper Öner, Hüseyin Ince, and Jasmin Ortak.
    • Klinik für Innere Medizin - Kardiologie, Allgemeine Innere Medizin und konservative Intensivmedizin, Vivantes Klinikum am Urban, Dieffenbachstr. 1, 10967, Berlin, Deutschland. sebastian.feickert@vivantes.de.
    • Internist (Berl). 2022 Feb 1; 63 (2): 230-237.

    BackgroundPatients with atrial fibrillation are at a significantly increased risk of thromboembolic events, especially ischemic strokes. Oral anticoagulation reduces this risk, but cannot be used in some patients for various reasons and is associated with a relevantly increased risk of bleeding. As an alternative for prophylaxis of thromboembolic events in patients with atrial fibrillation, there are different options of left atrial appendage closure.AimThis article explains the possibilities of interventional atrial occlusion as well as the suitable patient clientele using an overview of the currently available systems for atrial occlusion, a guideline for patient selection and a summary of the current scientific data.Conclusion And Available Scientific DataIn carefully selected patients suffering from atrial fibrillation with relative or absolute contraindications for oral anticoagulation, interventional closure of the atrial appendage is a safe alternative for prophylaxis against thromboembolic events. The currently available scientific evidence from randomized controlled trials is sparse. Nevertheless, extensive amounts of registry study data suggest a benefit, while the results of several large randomized controlled trials are expected in the coming years.© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

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