[Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation: is left atrial appendage closure an alternative for anticoagulation?]

The left atrial appendage (LAA) is the main source of cardioembolic stroke in patients with atrial fibrillation without valvular disease. Oral anticoagulation (OAC) has proven effective for preventing strokes associated with atrial fibrillation but is complicated by inherent bleeding risk and therapeutic compliance. Mechanical closure of the left atrial appendage seems an attractive alternative, especially in patients for whom long-term oral anticoagulation is not a good option. In the past decade, several percutaneous techniques have become available for this, including the WATCHMAN device. Randomized trials with the WATCHMAN device suggest that closure of the left atrial appendage is not inferior to oral anticoagulation in stroke prevention and that additionally there is reduced bleeding. Prospective registry studies of patients with contraindications for oral anticoagulation confirm that closure of the left atrial appendage is an attractive alternative to anticoagulation. Ongoing investigations are focused on reducing complications of the closure procedure, the lowest form of anticoagulation, comparing existing techniques and comparing left atrial appendage closure with direct oral anticoagulants.