[Percutaneous elimination of the left atrium appendage - who and when to qualify?] / Zabieg przezskórnej eliminacji uszka lewego przedsionka serca ­ kogo i kiedy kwalifikowac?

Percutaneous left atrial appendage (LAAO) is an alternative therapeutic option for the prevention of thromboembolic complications in patients with atrial fibrillation who, for various reasons, do not qualify for longterm treatment with oral anticoagulants. Despite the high percentage of implantation success and an acceptable percentage of surgical complications, this method is not a procedure of choice but only a treatment option in a selected group of patients. Randomized trials have shown that LAAO is as effective as warfarin in preventing stroke, systemic embolism or cardiovascular death.

[The current state of knowledge on the percutaneous elimination of the left atrial appendage based on data from randomized trials and clinical registries]. / Aktualny stan wiedzy na temat przezskórnej eliminacji uszka lewego przedsionka serca na podstawie danych z badan randomizowanych i rejestrów klinicznych.

Percutaneous left atrial appendage occlusion (LAAO) is a well known form of thromboembolism prophylaxis in patients at high risk of thromboembolism and with serious bleeding complications during oral anticoagulation (OAC/NOAC). Despite high safety profile and high efficiency, LAAO cannot be proposed as equivalent to OAC/NOAC but only as an alternative method which may be consider in specific group of patients. According to current data LAAO is not worse than OAC in stroke, systemic embolism and cardiovascular death prevention, however it is associated with a higher percentage of periprocedural adverse events. Nevertheless, long term observation showed statistically significant reduction in total mortality and cardiovascular mortality in patients who underwent LAAO compared to OAC.