Current views on the prevention of thromboembolic complications in atrial fibrillation

Abstract

Atrial fibrillation ( AF) is the most common arrhythmia and a direct cause of thromboembolic complications. The most common site of thrombus formation is the left auricle also referred to as the left atrial appendage (LAA). Pharmacotherapy with vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOACs) as well as percutaneous and surgical interventions have all been used to prevent these complications. Interventional management is the treatment of choice in patients with contraindications to oral anticoagulants; the efficacy of such management is comparable to that of pharmacotherapy while the risk of adverse events, ie., severe haemorrhage or haemorrhagic stroke, is lower. Hence, some extensions to the existing indications for interventional treatment might be worth considering under specific clinical circumstances. A hybrid therapy combining left atrial appendage occlusion (LAAO) with AF ablation seems to hold particularly notable potential due to high therapeutic efficacy unassociated with a significant increase in complication rates.