Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke?

TY - JOUR

T1 - Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke?

AU - Domínguez, Helena

AU - Madsen, Christoffer Valdorff

AU - Westh, Oliver Nøhr Hjorth

AU - Pallesen, Peter Appel

AU - Carrranza, Christian Lildal

AU - Irmukhamedov, Akhmadjon

AU - Park-Hansen, Jesper

PY - 2018/1

Y1 - 2018/1

N2 - 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. Summary: 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.

AB - 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. Summary: 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.

KW - Atrial fibrillation

KW - Cardiac surgery

KW - Left atrial appendage

KW - Stroke

KW - Thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85052670533&partnerID=8YFLogxK

U2 - 10.1007/s11886-018-1033-4

DO - 10.1007/s11886-018-1033-4

M3 - Review

C2 - 30171381

AN - SCOPUS:85052670533

SN - 1523-3782

VL - 20

JO - Current Cardiology Reports

JF - Current Cardiology Reports

IS - 10

M1 - 99

ER -