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(Stroke. 2007;38:e77.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Arguments Against Left Atrial Appendage Occlusion for Stroke Prevention

2nd Medical Department, Krankenanstalt Rudolfstiftung, Wien, Austria

Josef Finsterer, MD

Krankenanstalt Rudolfstiftung, Wien, Austria

Birke Schneider, MD

Klinik für Kardiologie, Sana Kliniken Lübeck, Lübeck, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

With great interest we read the article by Onalan et al about left atrial appendage (LAA) exclusion for stroke prevention in nonrheumatic atrial fibrillation (AF).¹ We share the author’s concerns about the hazards of this procedure and would like to emphasize additional arguments.

There is no evidence that thromboembolism in AF exclusively derives from LAA thrombi detected by transesophageal echocardiography. The prevalences (4% to 21%) of LAA-thrombi were found in studies of acutely sick patients, patients before cardioversion, cardiac surgery or after recent embolism. Contrarily, when prospectively investigating clinically stable outpatients with AF and no recent embolism by transesophageal echocardiography, the prevalence of LAA thrombi was only 2.5%, and during a follow-up of 58 months, LAA thrombus did not predict stroke/embolism.²

The benefit of LAA exclusion in preventing stroke/embolism has never been proven by a prospective randomized trial. A retrospective study of 205 patients undergoing transesophageal echocardiography after mitral valve replacement suggests a reduced rate of ischemic events after LAA ligation.³ In a further study of 437 patients undergoing open heart surgery and LAA exclusion, no later strokes were attributed to AF and no thrombi were detected. Unfortunately, this study reports neither duration and methods of follow-up nor the number of patients investigated and the antithrombotic therapy applied.⁴ In contrast, 2 trials including 136 and 320 patients undergoing surgical LAA closure at the time of mitral valve surgery revealed either no benefit or even an increased risk of thromboembolic events.^5,6

How can incomplete surgical LAA exclusion be . . . [Full Text of this Article]