Percutaneous Left Atrial Appendage Closure

Stroke is a devastating complication of atrial fibrillation, and many patients do not benefit from pharmacological prophylaxis with oral anticoagulants even though risk scores clearly indicate a benefice. Vitamin K antagonists remain the gold standard of therapy but treatment is challenging, constraining for the patient and often outside the therapeutic range. Even the simpler treatment with novel anticoagulants is widely underused in this population, and bleeding risks remain relatively high with these molecules. For these reasons, interest has grown in non-pharmacologic prevention of stroke, and, over the past 20 years, percutaneous left atrial appendage closure has emerged as the most promising technique. Even though large, randomized trials are lacking, these procedures appear to be safe and effective, especially in the hands of experienced operators. For the moment, percutaneous LAA occlusion benefits from a class IIb indication in European guidelines for patients at high risk of bleeding and contraindications for anticoagulation. Additional evidence from randomized trials comparing LAA closure to warfarin and novel anticoagulants is needed before extending the indications to other patients.