1. Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke?
- Author
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Domínguez H, Madsen CV, Westh ONH, Pallesen PA, Carrranza CL, Irmukhamedov A, and Park-Hansen J
- Subjects
- Anticoagulants adverse effects, Anticoagulants therapeutic use, Atrial Appendage surgery, Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Humans, Ligation, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Stroke etiology, Thromboembolism etiology, Time Factors, Treatment Outcome, Atrial Appendage physiopathology, Atrial Fibrillation therapy, Cardiac Catheterization adverse effects, Stroke prevention & control, Thromboembolism prevention & control
- Abstract
Purpose of Review: Stroke is the most feared complication of atrial fibrillation. To prevent stroke, left atrial appendage exclusion has been targeted, as it is the prevalent site for formation of heart thrombi during atrial fibrillation. We review the historic development of methods for exclusion of the left atrial appendage and the evidence to support its amputation during routine cardiac surgery., Recent Findings: Evidence is not yet sufficient to routinely recommend left atrial exclusion during heart surgery, despite a high prevalence of postoperative atrial fibrillation. Observational studies indicate that electrical isolation of scarring from clip or suture techniques reduces the arrhythmogenic substrate. Randomized studies comparing different methods of closure of the left atrial appendage before amputation do not exist. Such studies are therefore warranted, as well as studies that can elucidate whether amputation is superior to leaving the left atrial appendage stump. Potentially, thrombogenic remaining pouch after closure should be addressed.
- Published
- 2018
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