Left atrial appendage closure - Where are we now?

Abstract

Atrial fibrillation is the most common arrhythmia with significant morbidity and mortality. The most feared complication of atrial fibrillation remains stroke. While anticoagulation remains the cornerstone of stroke prevention in patients with atrial fibrillation, patients continue to be under treated due to misinformation, intolerance, as well as relative  and absolute contraindications. The left atrial appendage has been implicated in thrombus formation in patients with atrial fibrillation. Left atrial appendage closure has been devised as an alternative strategy for decreasing stroke risk in patients with atrial fibrillation. Percutaneous left atrial appendage closure is currently being developed as a possible alternative to anticoagulation in patients at high risk for stroke especially among patients with relative or absolute contraindications to long-term anticoagulation. The PROTECT AF trials provides the first randomized, controlled trial data demonstrating proof of concept of left atrial appendage closure with the WATCHMAN device. Further data are explored in this review. Limited data are available with other devices. However, several devices are promising entries into the realm of left atrial appendage closure offering options to an under treated patient population.