Catheter-based left atrial appendage closure

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an increased risk of stroke and systemic embolism. While anticoagulation reduces the risk of thromboembolism in AF, safe and consistent long-term treatment can be challenging with oral anticoagulation regimens. The left atrial appendage (LAA) is thought to be the major source of thromboembolism in AF. Novel, mechanical catheter-based strategies have been developed to exclude communication between the LAA and the left atrium in order to reduce the risk of thromboembolism in AF without the need for long-term OAC. Transesophageal echocardiography (TEE) imaging plays a critical role in transcatheter closure of the LAA. This chapter provides details on the multiple roles of TEE in LAA closure ranging from baseline evaluation (to establish eligibility and correct size of device) to procedural guidance (including transseptal puncture) to later follow up.