Atrial fibrillation (AF) is associated with an increased risk of stroke and systemic embolism, and the left atrial appendage (LAA) has been identified as a principal source of thromboembolism in these patients. While oral anticoagulation is the current standard of care, LAA closure (LAAC) emerges as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF. Moderate-sized randomized clinical studies have provided data for the efficacy and safety of catheter-based LAAC, largely compared with vitamin K antagonists. LAA device iterations, advances in pre- and peri-procedural imaging, and implantation techniques continue to increase the efficacy and safety of LAAC. More data about efficacy and safety of LAAC have been collected, and several randomized clinical trials are currently underway to compare LAAC with best medical care (including non-vitamin K antagonist oral anticoagulants) in different clinical settings. Surgical LAAC in patients with AF undergoing cardiac surgery reduced the risk of stroke on background of anticoagulation therapy in the LAAOS III study. In this review, we describe the rapidly evolving field of LAAC and discuss recent clinical data, ongoing studies, open questions, and current limitations of LAAC.

中文翻译：

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左心耳封堵术预防心房颤动中风​​：现状和前景


心房颤动 (AF) 与中风和全身性栓塞风险增加相关，左心耳 (LAA) 已被确定为这些患者血栓栓塞的主要来源。虽然口服抗凝药是当前的护理标准，但左心耳封堵术 (LAAC) 作为一种替代或补充治疗方法出现，可降低 AF 患者中风或全身性栓塞的风险。中等规模的随机临床研究提供了基于导管的 LAAC 的有效性和安全性数据，主要与维生素 K 拮抗剂进行了比较。 LAA 装置的迭代、术前和围术期成像的进步以及植入技术不断提高 LAAC 的有效性和安全性。关于 LAAC 疗效和安全性的更多数据已经收集，目前正在进行多项随机临床试验，以在不同临床环境下将 LAAC 与最佳医疗护理（包括非维生素 K 拮抗剂口服抗凝剂）进行比较。在 LAAOS III 研究中，接受心脏手术的 AF 患者接受手术 LAAC 可以降低抗凝治疗背景下中风的风险。在这篇综述中，我们描述了快速发展的 LAAC 领域，并讨论了 LAAC 的最新临床数据、正在进行的研究、悬而未决的问题和当前的局限性。