Defining the role of left atrial appendage closure in atrial fibrillation.

Despite more than 10 years’ clinical experience, the role of percutaneous left atrial appendage (LAA) closure in patients with nonvalvular atrial fibrillation (NVAF) is still elusive. The reasons include the complexity of the procedure, the limited clinical information from controlled trials, and recent developments in the field of anticoagulation. A weak, grade IIb recommendation (ie, usefulness/efficacy less well established by evidence/ opinion) was released by the 2012 European atrial fibrillation guidelines, reflecting uncertainty over LAA closure in patients with a high stroke risk and contraindications for long-term oral anticoagulation. A valuable addition to our current knowledge of LAA closure in patients with NVAF is provided by the experience of López-Mı́nguez et al. with the use of the Amplatzer occlusion device (Amplatzer Cardiac Plug [ACP]). Some practical questions and concerns relating to LAA closure in patients are discussed below, with the aim of helping readers shape an informed opinion about this transcatheter procedure.