Stroke Risk Factors - Guidelines

STROKE RISK FACTORS

Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of ischemic stroke.¹Left atrial appendage (LAA) closure reduces the risk of stroke in non-valvular AF (NVAF) patients who are seeking an alternative to oral anticoagulants.^2,3

2016 EUROPEAN SOCIETY OF CARDIOLOGY (ESC) GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION DEVELOPED IN COLLABORATION WITH THE EUROPEAN ASSOCIATION OF CARDIOTHORACIC SURGERY (EACTS)¹

ACCESS TO ALL TREATMENT OPTIONS FOR AF

Structured support for lifestyle changes

Anticoagulation

Rate control

CATHETER AND SURGICAL INTERVENTIONS (ABLATION, LAA OCCLUDER, AF SURGERY, ETC.)

Antiarrhythmic drugs

Complex management decisions underpinned by an AF Heart Team

RECOMMENDATION	CLASS	LEVEL
After surgical occlusion or exclusion of the LAA, it is recommended to continue anticoagulation in at-risk patients with AF for stroke prevention	I	B
LAA occlusion may be considered for stroke prevention in patients with AF and contraindications for long-term oral anticoagulation treatment (e.g. those with a previous life- threatening bleed without reversible cause)	IIb	B
Surgical occlusion or exclusion of the LAA may be considered for stroke prevention in patients with AF undergoing open cardiac surgery.	IIb	B
Surgical occlusion or exclusion of the LAA may be considered for stroke prevention in patients with AF undergoing thoracoscopic AF surgery	IIb	B

PROFESSOR HANS-CHRISTOPH DIENER

Prevention of stroke in patients with AF:

To learn more about the proof of concept studies that led to the current class IIb recommendation for LAAO in the management of AF, please click on the publication link below:

Publication

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TV

Left Atrial Appendage Occlusion (LAAO)

Anatomical overview of the heart

Anatomical overview of the heart with focus on ASD, PFO and LAAO

LAAO Summit - Imaging debate: Mini TEE

Imaging debate: defending Mini TEE

N. Wunderlich

LAAO Summit - New data & future trials

New data, ongoing & future trials

K. Kaczmarek

LAAO Summit - Debate: Factor XI inhibitors

Debate: Factor XI inhibitors are close

J. Camm

LAAO Summit - Debate: Factor XI inhibitors

Debate: Factor XI inhibitors are far away

H.C. Diener

LAAO Summit - Imaging debate: TEE

Imaging debate: defending TEE

L. Boldt

LAAO Summit - Imaging debate: ICE

Imaging debate: defending ICE

J. Saw

LAAO Summit - Pre-procedural imaging

Pre-procedural imaging modalities

O. de Backer

LAAO Summit - LAA anatomy focusing

LAA anatomy focusing on complexity

A. Cook, T. Lewalter

HUB

PDL Analysis Summary

Peri-device leak Analysis Summary

PDL Technical Analysis by Dr. Lakkiredy

Peri-device leak: Technical analysis by Dr. Lakkiredy TCT 2022

Amulet IDE Results

Amulet IDE 3yr outcomes

LAAO Neuro Brochure

LAAO Brochure for Neurologists

LAAO Referral Brochure

LAAO Referral Best Practices Brochure

LAAO Patient Guide

LAAO Patient Guide

Nephrologist LAA Therapy Deck

LAA Therapy Presentation for Nephrologists

Clinical insights: Amulet™

Clinical Insights: Amplatzer™ Amulet™ LAA Occluder

Clinical insights: LAAO

Clinical insights: Structural interventions Amplatzer™ Cardiac Plug & Amplatzer™ Amulet™

Monitoring for AF prior to PFO closure

Monitoring for atrial fibrillation prior to patent foramen ovale closure

References

Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–2962. doi.org/10.1093/eurheartj/ehw210.
Diener H-C, Landmesser U. Percutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. Future Neurol. 2020;15(3). doi.org/10.2217/fnl-2020-0001.