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

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Helena Domínguez, Christoffer Valdorff Madsen, Oliver Nøhr Hjorth Westh, Peter Appel Pallesen, Christian Lildal Carrranza, Akhmadjon Irmukhamedov, Jesper Park-Hansen

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.

Original languageEnglish
Article number99
JournalCurrent Cardiology Reports
Volume20
Issue number10
Number of pages6
ISSN1523-3782
DOIs
Publication statusPublished - Jan 2018

    Research areas

  • Atrial fibrillation, Cardiac surgery, Left atrial appendage, Stroke, Thromboembolism

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