Left Atrial Appendage Occlusion - 2025 Update and International Perspective (non-ACE)-Left Atrial Appendage Occlusion - 2025 Update and International Perspective (non-ACE)

Video Transcription

Video Summary

The lecture focuses on the evolution and current status of left atrial appendage (LAA) closure devices, namely the Watchman device, over the past decade. Since its approval, over 500,000 procedures have been performed. Initially approved for patients with non-valvular atrial fibrillation as an alternative to long-term warfarin therapy, the device shows superiority in reducing hemorrhagic strokes and all-cause death, primarily due to decreased bleeding risks. The evolution of LAA closure's indications is notable; guidelines from 2019 suggested it for high-risk stroke patients contraindicated to long-term anticoagulation. These guidelines were revised in 2023, upgrading certain recommendations and introducing patient-preference considerations.<br /><br />The Watchman's efficacy and safety over anticoagulation were analyzed, with ongoing studies like the option study hinting at expanding its use in conjunction with atrial fibrillation ablations. Further studies like the champion and catalyst may broaden indications even more, possibly positioning these devices as first-line therapy.<br /><br />Discussions also touched on the impact of various antithrombotic regimens post-procedure, emphasizing the benefits of using direct oral anticoagulants (DOACs) alone over dual antiplatelet therapy (DAPT) to minimize thrombus risks on the device. Technological advances such as 3D and 4D intracardiac echocardiography (ICE) increasingly support procedural success while potentially reducing patient discomfort compared to traditional transesophageal echocardiography (TEE).<br /><br />Challenges remain in managing peri-device leaks and device-related thrombus—the session highlighted that clinical decisions should be personalized, acknowledging procedural techniques, patient-specific risks, and potential long-term outcomes.

Keywords

left atrial appendage closure

Watchman device

non-valvular atrial fibrillation

hemorrhagic stroke reduction

anticoagulation alternatives

direct oral anticoagulants

atrial fibrillation ablation

intracardiac echocardiography

peri-device leaks

patient-specific risks