A patient with permanent atrial fibrillation and very high bleeding risk – when is the optimal time to refer for left atrial appendage occluder device implantation?

Introduction: Most patients with atrial fibrillation (AF) should receive anticoagulant therapy to reduce the risk of systemic embolization. However, there are varying degrees of bleeding risk associated with anticoagulation thus reducing the number of candidates for this therapy. The left atrial appendage (LAA) is the usual source of clot embolisms. Percutaneous approaches, often referred to as LAA exclusion procedures, mechanically prevent embolization of LAA thrombi.1,2 We consider the placement of percutaneous LAA Occlusion Device (Amplatzer Amulet device) a good choice for patients with high bleeding risk.