Excision of the left atrial appendage

As discussed, at least 90% of the emboli that cause AF-related strokes arise in the left atrial appendage (LAA).33 So, surgical excision or occlusion of the LAA may be an option for some patients, especially those undergoing cardiac surgery for another indication.6 Recent technological advances, such as percutaneous and intracardiac devices, make closing the LAA easier and are, therefore, more effective than conventional surgery.6

LAA excision had no significant effect on the risk of stroke or systemic embolism during a 2.7 year follow up compared to the control group (1.75% and 1.87% per year respectively).7 So, the ESC/EHRA guidelines suggest that patients at risk of stroke should continue anticoagulation following LAA occlusion or exclusion.5 The guidelines recommend considering LAA occlusion for stroke prevention in AF patients with contra-indications for long-term anticoagulants, such as those with a history of life-threatening bleeds without a reversible cause and those undergoing cardiac surgery or thoracoscopic AF surgery.5

In the next section we focus on catheter ablation

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