Atrial fibrillation (AF) is the most common sustained
cardiac arrhythmia, and is associated with a fivefold increase in the risk of
ischemic stroke and systemic embolism.
Left atrial appendage (LAA) is the source of thrombi
in up to 90% of patients with nonvalvular atrial fibrillation (AF). Although
thromboembolic prophylaxis by means of oral anticoagulants (OAC) has been shown
to be very effective (OAC), they also confer an inevitably risk of serious
Catheter ablation (CA) is an effective treatment for
symptomatic AF but its role in stroke prevention remains unproved. Recently, LAA percutaneous occlusion has been
demonstrated to be equivalent to OACs in reducing thromboembolic events.
The aim of this review is to describe the rationale,
feasibility, outcomes and technique of a combined procedure of AFCA and
percutaneous LAAO, two percutaneous
interventions that share some procedural issues and technical requirements, in
patients with symptomatic drug-refractory AF, high risk of stroke, and
contraindications to OACs.
Credits: Ignacio García-Bolao; Naiara Calvo; Alfonso Macias; Joaquin Barba; Naihari Salterain; Pablo Ramos; Gabriel Ballesteros; Renzo Neglia