Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, morbidity and overall mortality. So far, oral anticoagulation (OAC) is the standard of care for stroke prevention, either with vitamin K antagonists or with non-vitamin K oral anticoagulants (NOACs). The left atrial appendage (LAA) can be eliminated by epicardial or endocardial exclusion. Left atrial appendage closure (LAAC) represents a mechanical thromboprophylaxis - which has also been termed mechanical vaccination - against stroke, bleeding and death.
Areas covered: Studies show that LAAC provides stroke prevention comparable to (N)OAC. Additionally, a notable reduction of bleeding events and its associated mortality is achieved by LAAC. With accruing experience and advances in patient selection, procedural planning, implantation techniques and devices, contemporary LAAC registries report high rates of success and low rates of complications.
Expert opinion: The decision to provide the most appropriate stroke prevention for patients with AF (OAC, NOAC or LAAC) needs to be individualized to patients' thromboembolic and bleeding risk and life expectancy. This review on LAAC provides an update on contemporary devices and techniques, as well as recommendations for patient selection and management.
Keywords: Atrial fibrillation; bleeding; left atrial appendage closure; oral anticoagulation; stroke prevention.