Left atrial appendage occlusion in patients with Nonvalvular Atrial Fibrillation

Abstract

To review the scientific literature on left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF), evaluating its benefits in the prevention of thromboembolic events, particularly stroke, in patients with or without prior use of oral anticoagulants (OA). Methods: This is a systematic review without meta-analysis, with a literature search conducted in the PubMed and SciELO databases between January 2015 and July 2024. Studies with prospective or retrospective designs, in Portuguese or English, involving human subjects and addressing NVAF and LAAO were included. Results: LAAO has shown similar efficacy to new OA in preventing ischemic stroke, with a lower incidence of major bleeding. Double occlusion devices exhibited a lower rate of peri-device leakage and complications, although new models of single occlusion devices showed similar and even superior results. Imaging techniques, such as 3D computed tomography angiography, were crucial in selecting the device. Transseptal puncture assisted by guidewire was more efficient and safer. LAAO combined with procedures such as transcatheter aortic valve implantation or percutaneous coronary intervention proved to be feasible. The high cost of the LAAO procedure still limits its widespread application. Conclusions: LAAO is an effective and safe alternative for the prevention of thromboembolic complications in patients with NVAF, especially for those with contraindications to chronic use of OA. Technical advancements and new devices have the potential to expand its clinical use and improve patients' quality of life.