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(Circulation. 2009;120:1919-1926.)
© 2009 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Does left atrial appendage occlusion eliminate the need for warfarin?

Left Atrial Appendage Occlusion Eliminates the Need for Warfarin

David R. Holmes, Jr, MD; Robert S. Schwartz, MD

From the Mayo Clinic, Rochester, Minn (D.R.H.); and Minneapolis Heart Institute, Minneapolis, Minn (R.S.S.).

Correspondence to David R. Holmes, Jr, MD, Mayo Clinic, 200 First St SW, SMH MB 4–523, Rochester, MN 55905. E-mail holmes.david@mayo.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Stroke is the third leading cause of mortality and is a leading cause of disability in the world today. Current estimates suggest a stroke incidence of 780 000 cases yearly, and it remains the most feared complication of cardiovascular disease.¹ Brain ischemia is multifactorial—it may result from carotid artery occlusion, plaque embolization, and aortic atheromatous debris. A major cause is cardiac emboli, most commonly occurring in patients with atrial fibrillation. This association is assuming increased importance as atrial fibrillation markedly increases with the aging population.

Response by Whitlock et al on p 1926

Atrial fibrillation is the most common sustained cardiac arrhythmia.^2–11 Data from the Framingham study suggest a high incidence of atrial fibrillation.³ By age 40, 26% of men and 23% of women can expect to have at least 1 episode of atrial fibrillation in their remaining years.⁷ The overall rate of ischemic stroke among patients with nonrheumatic atrial fibrillation averages 5% per year, and this rate increases with age.⁷ The overall proportion of strokes thought to be due to atrial fibrillation was reported as 14.7%, a number that steadily increases with age from 6.7% (ages 50 to 59 years) to 36.2% for patients aged 80 to 89 years.¹² Moreover, cardioembolic strokes are associated with the worst long-term prognosis. Henricksson et al¹³ evaluated survival after stroke in 105 074 patients with and without atrial fibrillation from the Swedish Stroke Registry from 2001 to 2005. In 31 821 patients with atrial fibrillation, a significantly higher death risk (relative risk 1.46, . . . [Full Text of this Article]