Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One of its most devastating complication is the development of thromboembolism leading to stroke. The left atrial appendage (LAA) has been shown to be the site of thrombus formation in the majority of strokes associated with AF. Anticoagulation with warfarin has been the treatment of choice for prevention of embolic events in these patients, but it does have significant limitations including bleeding, need for continued follow-up blood tests, and drug-drug interactions. Although newer anticoagulants have been developed, they still have the potential side effect of causing significant bleeding. Closure or exclusion of the LAA has emerged as an alternative therapeutic approach to medical therapy. The aim of this article is to review the anatomy and physiology of the LAA, discuss the various treatment strategies for stroke prevention, review the current devices and technologies available for LAA occlusion, and discuss some of the more recent data available on these technologies.
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