Left atrial appendage occlusion in everyday clinical practice:Closing the gap

Despite the deeply rooted conviction that oral anticoagulation therapy is the primary strategy to prevent ischemic strokes in patients with atrial fibrillation, non-adherence to oral anticoagulation therapy is common. Percutaneous occlusion of the left atrial appendage is a mechanical alternative to oral anticoagulation therapy for stroke prevention. Current guidelines recommend considering left atrial appendage occlusion in patients with contraindications for long-term oral anticoagulation use. This thesis investigates the effectiveness and safety of percutaneous left atrial appendage occlusion in everyday clinical practice. The objectives were to optimize the procedure, improve post-procedural care, and achieve better patient selection.This thesis consists of two parts. The first part focuses on the procedural aspects of percutaneous left atrial appendage occlusion, providing insights into how patients can be optimally treated with this procedure in contemporary practice. For example, by using mini- and micro-probes during transesophageal echocardiography, thus eliminating the need for general anesthesia. The second part addresses post-procedural treatment and clinical outcomes after left atrial appendage occlusion. It demonstrates, among other things, that cardioversion can safely occur after left atrial appendage occlusion, that left atrial appendage occlusion remains effective in the long term in everyday clinical practice, that it is meaningful to perform left atrial appendage occlusion in patients who have experienced thromboembolic complications despite anticoagulation use, and also describes some predictors of the feared complications of thrombus formation on the device