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

Current Cardiology Reports
Helena DomínguezJesper Park-Hansen

Abstract

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. 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. 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.

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Citations

Aug 21, 2020·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Zhenhua ZhangHaibo Zhang
Dec 18, 2020·Journal of Cardiovascular Electrophysiology·Annabelle Santos VolgmanUNKNOWN American College of Cardiology Committee on Cardiovascular Disease in Women
Oct 27, 2021·Current Opinion in Cardiology·Rong BaiWilber W Su

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Methods Mentioned

BETA
amputation
amputations

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