Where We Stand on Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation.

PURPOSE OF REVIEW Anticoagulant therapy effectively reduces the incidence of stroke in patients with atrial fibrillation (AF) but is underutilized and frequently contraindicated. The left atrial appendage (LAA) is the primary site of thrombus formation in AF patients. Surgical and percutaneous appendage closure has been evaluated as a site-specific therapy to reduce systemic thromboembolism. RECENT FINDINGS We will review LAA closure techniques, examine recent outcome data, and discuss the indications for, and potential complications of, each approach. Randomized data examining surgical LAA closure and epicardial closure with the LARIAT device are lacking. High quality, randomized data supports the efficacy of the WATCHMAN device for stroke prevention in patients with AF.