Evidence and Challenges in Left Atrial Appendage Management

• Published in: Annals of Thoracic and Cardiovascular Surgery Vol. 28; no. 1; pp. 1 - 17
• Main Authors: Yamamoto, Taira, Endo, Daisuke, Matsushita, Satoshi, Shimada, Akie, Nakanishi, Keisuke, Asai, Tohru, Amano, Atsushi
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 01.01.2022
• Subjects: Anticoagulants - adverse effects; Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - therapy; cardiac surgery; endocrine function; Humans; left atrial appendage; Prospective Studies; Review; Stroke; Treatment Outcome; cardiac surgery; atrial fibrillation; left atrial appendage; endocrine function; stroke
• ISSN: 1341-1098; 2186-1005
• DOI: 10.5761/atcs.ra.21-00040

This review aimed to discuss the anatomical properties of the left atrial appendage (LAA), its relationship with atrial fibrillation (AF), effectiveness of LAA occlusion (LAAO), techniques, and new devices used to perform this procedure. An electronic search was performed to identify studies, in the English language, on LAA management. Searches were performed on PubMed Central, Scopus, and Medline from the dates of database inception to February 2020. For the assessed papers, data were extracted from the reviewed text, tables, and figures, by two independent authors. Anticoagulant therapy for patients with AF has proven beneficial and is highly recommended, but it is challenging for many patients to maintain optimal treatment. Surgery is the most cost-effective option; surgical methods include simple LAA resection, thoracoscopic surgery, and catheter treatment. Each procedure has its advantages and disadvantages, and many prospective studies have been conducted to evaluate various treatment methods. In managing the LAA, dissection of the LAA, such as changes in its shape and size due to remodeling during AF, changes in autonomic nerve function, and thrombosis, must be understood anatomically and physiologically. We believe that early treatment intervention for the LAA should be considered particularly in cases of recurrent AF.