Percutaneous left atrial appendage exclusion

Percutaneous exclusion of the left atrial appendage is currently an alternative technique to the anticoagulation therapy regarding the prevention of stroke in patients with non-valvular atrial fibrillation. With the growing aging population the absolute number of patients likely to benefit from this technique will increase in the near future. Despite international guidelines, mentioning that oral anticoagulation therapy is the most effective available prophylactic approach in patients with atrial fibrillation at high risk of thromboembolic events, approximately 40% of them do not receive anticoagulation therapy for reasons sometimes justified (high risk of bleeding, contraindications) and sometimes only exclusively driven by the fear of bleeding risk. Anatomical and echocardiographic assessment have shown that the left atrial appendage was the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation. The randomised PROTECT AF trial demonstrated the non-inferiority of left atrial appendage exclusdion (Watchman (TM) device, Boston Scientific) in comparison to anticoagulation therapy considering the risk of stroke. This procedure usually performed under general anesthesia and transesophageal echocardiography guidance is not without risk (pericardial effusion) requiring skilled operators and surgical back-up. Many closure systems are developing to expand in the future the scope of this technique. In France, this act has to be registered so as to obtain reimbursing in order to increase the number of patients.