The left atrial appendage: from embryology to prevention of thromboembolism

• Published in: European heart journal Vol. 38; no. 12; pp. 877 - 887
• Main Authors: Patti, Giuseppe, Pengo, Vittorio, Marcucci, Rossella, Cirillo, Plinio, Renda, Giulia, Santilli, Francesca, Calabrò, Paolo, De Caterina, Alberto Ranieri, Cavallari, Ilaria, Ricottini, Elisabetta, Parato, Vito Maurizio, Zoppellaro, Giacomo, Di Gioia, Giuseppe, Sedati, Pietro, Cicchitti, Vincenzo, Davì, Giovanni, Golia, Enrica, Pariggiano, Ivana, Simeone, Paola, Abbate, Rosanna, Prisco, Domenico, Zimarino, Marco, Sofi, Francesco, Andreotti, Felicita, De Caterina, Raffaele
• Format: Journal Article
• Language: English
• Published: England 21.03.2017
• Subjects: Atrial Appendage - anatomy & histology; Atrial Appendage - embryology; Atrial Appendage - physiology; Atrial Fibrillation - complications; Blood Flow Velocity - physiology; Echocardiography; Endothelium, Vascular - physiology; Humans; Magnetic Resonance Angiography; Septal Occluder Device; Stroke - prevention & control; Therapeutic Occlusion - instrumentation; Therapeutic Occlusion - methods; Thromboembolism - etiology; Thromboembolism - prevention & control; Tomography, X-Ray Computed; NOACs; Occlusion devices; Systemic embolism; Anticoagulants; Stroke; Atrial fibrillation; Non-vitamin K antagonist oral anticoagulants; Left atrial appendage; Thromboembolism
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehw159

The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches.