Percutaneous left atrial appendage occlusion in South Africa

Atrial fibrillation (AF) is a global challenge, with an estimated prevalence of 1 - 2% in the general population.[1] The prevalence increases with age,[1] and AF affects up to 15% of octogenarians. AF is independently associated with mortality, cardiac failure and non-fatal stroke.[1,2] Thromboprophylaxis for high-risk patients is provided with oral anticoagulation (OAC) using vitamin K antagonists (VKAs), such as warfarin. Meta-analysis of 5 randomised clinical trials demonstrated that OAC results in a relative risk reduction of 68% for ischaemic stroke.[3] Over the past decade, the use of novel oral anticoagulants (NOACs) has gained traction, with randomised trials showing non-inferiority of these drugs for the prevention of ischaemic stroke compared with VKAs, as well as a lower risk of cerebrovascular haemorrhage. VKAs or NOACs, however, are best avoided in patients who are intolerant to their effects (e.g. life-threatening haemorrhage), non-adherent or have an unacceptably high bleeding risk.