Left Atrial Appendage Exclusion in Patients with Atrial Fibrillation:
Should it become Standard of Care?
Atrial Fibrillation (AF) is the most common arrhythmia affecting the
general population, with the prevalence projected to reach 12.1 million
cases in 2030. Recently, attention has focused on the role of the Left
Atrial Appendage (LAA) and its association with the most feared
complication of AF: thromboembolism. Common sense indicates that the LAA
should be excluded in all patients with AF; however, procedures to
exclude the LAA have yet to become the standard of care. Recent studies
in the cardiac surgery literature , , indicate a clear benefit of LAA
exclusion amongst patients with AF undergoing cardiac surgery.
Interestingly, this benefit was found to extend well beyond the
postoperative period, in cohorts that were equally anticoagulated and
had similar CHA2DS2-VASC scores. It appears reasonable that our medical
community should strongly consider initiating a prospective randomized
trial in an effort to fully elucidate the need for routine LAA exclusion
in this patient population.