Michael Glikson1; Rafael Wolff1; Gerhard Hindricks2; John Mandrola3; A. John Camm4; Gregory Y.H. Lip5,6; Laurent Fauchier7; Tim R. Betts8; Thorsten Lewalter9,10; Jacqueline Saw11; Apostolos Tzikas12; Leonid Sternik13; Fabian Nietlispach14; Sergio Berti15; Horst Sievert16,17,18,19; Stefan Bertog16; Bernhard Meier20
1. Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; 2. Heartcenter Leipzig at Leipzig University and Leipzig Heart Institute, Department of Electrophysiology, Leipzig, Germany; 3. Baptist Health Louisville, Louisville, KY, USA; 4. Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom; 5. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; 6. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 7. Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France; 8. Oxford University Hospitals NHS Foundation Trust, Oxford Biomedical Research Centre, Department of Cardiology, Oxford, United Kingdom; 9. Dept. of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany; 10. Dept. of Cardiology, University of Bonn, Bonn, Germany; 11. Vancouver General Hospital, University of British Columbia, Vancouver, Canada; 12. Structural & Congenital Heart Disease, AHEPA University Hospital & Interbalkan European Medical Center, Thessaloniki, Greece; 13. Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel; 14. Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland; 15. Heart Hospital-Fondazione C.N.R. Reg. Toscana G. Monasterio, Cardiology Department, Massa, Italy; 16. CardioVascular Center CVC, Cardiology and Angiology, Frankfurt, Germany; 17. Anglia Ruskin University, Chelmsford, United Kingdom; 18. University of California San Francisco, San Francisco, CA, USA; 19. Yunnan Hospital Fuwai, Kunming, China; 20. Cardiology, Cardiovascular Department, University Hospital Bern, Bern, Switzerland
Chapter 1. Background and pathophysiology of thrombus formation in the left atrium
The rationale for the quest to close the left atrial appendage (LAA) for stroke prevention is composed of three elements: the concept that atrial fibrillation (AF) causes strokes, the concept that strokes are associated with thrombus formation in the LAA, and that these thrombi cause strokes by embolisation to the cerebral circulation.
There are strong data supporting an association between AF and stroke. The Framingham study following 5,070 patients over 34 years demonstrated an approximately fivefold higher stroke risk in individuals with AF than in those without1. Though ...