Clinical Advances in Left Atrial Appendage (LAA) Closure Procedure

Dear Colleagues,

Almost daily, regardless of our specialization, we encounter patients affected by atrial fibrillation (AF), a condition with continuously increasing prevalence and incidence. While oral anticoagulants (OACs) such as vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC) are typically prescribed to mitigate the risk of thromboembolic events, we often face patients unable to tolerate OAC therapy due to various contraindications, including, but not limited to:

• History of major bleeding or high bleeding risk;
• Chronic kidney disease in dialytic therapy;
• Drug interactions and allergies;
• Lifestyle factors and patient compliance issues;
• Specific conditions such as advanced malignancies, chronic liver disease, or hemorrhagic tendencies associated with hematologic disorders.

For these patients, percutaneous left atrial appendage closure (LAAC) offers a promising alternative, a procedure with an efficacy and safety profile abundantly demonstrated by several studies.

The interdisciplinary implications of this procedure are profound. It is relevant not only to cardiologists but also to specialists in hematology, nephrology, gastroenterology, neurology, oncology, and other fields who manage patients with complex comorbidities. Collaborative decision making is crucial for identifying appropriate candidates for LAAC, considering the multifaceted clinical profiles and the nuanced risks and benefits for each individual patient.

In this Special Issue dedicated to recent advances in LAAC, we are interested in original and review articles that (1) assess short- and long-term clinical outcomes of LAAC in different clinical scenarios, (2) identify clinical scores to identify high-bleeding-risk patients who could benefit from LAAC, and that (3) discuss future research directions. We are also interested in “Expert consensus statements” on LAAC from different specialties.

I am keen to discuss how we can better integrate this procedure into our clinical practice to improve outcomes for our patients with atrial fibrillation and contraindications to OAC therapy. Your insights and collaboration would be invaluable in this endeavor.

Thank you for your attention to this important issue. I look forward to your contributions and collaboration.

Dr. Fabrizio Ugo
Dr. Gavino Casu
Guest Editors

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• left atrial appendage (LAA)
• left atrial appendage closure (LAAC)
• left atrial appendage occlusion (LAAO)
• left atrial appendage
• cardiac intervention
• structural intervention