Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faust bargain for left atrial appendage closure? —Authors’ reply

We thank Yakutet al. for their comments on our Point of view ‘Where are clots in atrial fibrillation? Did we have the wrong assumptions over the last decades?’. In the manuscript, we addressed how in the old literature the frequency of left atrial cavity thrombi is probably largely overestimated.1 In fact, based on an accurate review, and on our experience, the real frequency of atrial thrombi located outside the left appendage (LAA) is extremely low, and it might be an important rationale for LAA occlusion interventions. The aim of this last sentence was to give evidence to procedures focusing on LAA, not promoting LAA occlusion. This technique has emerged as a reasonable alternative for stroke prevention only in patients not suitable for anticoagulant therapy, as confirmed in the recent 2020 international guidelines on atrial fibrillation with a Class IIb indication.2 Although some scepticisms arisen from doubtful results of PROTECT and PREVAIL trial, LAA occlusion has confirmed its value of collecting other robust evidences in literature. In the recent PRAGUE-17, a high-risk patient cohort was randomized to receive Left Atrial Appendage Closure (LAAC) or Direct Oral AntiCoagulant (DOAC). At a median 19.9  months of follow-up, LAAC was non-inferior to Direct Oral AntiCoagulation (DOAC) in preventing major AF-related cardiovascular, neurological, and bleeding events.3 The ASAP study was designed for patients at high risk for stroke but ineligible for warfarin therapy. ...
Source: Europace - Category: Cardiology Source Type: research