The following are key points to remember from a state-of-the-art review on left atrial appendage closure (LAAC) for stroke prevention in atrial fibrillation (AF):

1. AF is associated with an increased risk of stroke and systemic embolism, and the LAA has been identified as a principal source of thromboembolism in these patients. Furthermore, because of changing demographics, the number of AF patients is expected to double in industrialized countries within the next two decades.
2. Patients with high risk for stroke have an indication for stroke preventive therapies consisting of either oral anticoagulation (OAC), percutaneous LAAC in case of high bleeding risk, or surgical LAAC in patients undergoing cardiac surgery.
3. While OAC is the current standard of care, LAAC has emerged as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF.
4. Moderate-sized randomized clinical studies have provided data for the efficacy and safety of catheter-based LAAC, largely compared with vitamin K antagonists.
5. This state-of-the-art review, describes the rapidly evolving field of LAAC and discusses recent clinical data, ongoing studies, open questions, and current limitations of LAAC.
6. Improvement of LAA devices as well as current developments of pre-, peri-, and post-procedural imaging and planning will aid in further improvements of safety of percutaneous LAAC.
7. The rapidly growing field of LAAC with expansion to lower-risk patient populations and novel indications in clinical studies warrants particular attention to unresolved issues in order to ensure long-term safety and efficacy.
8. In particular, the benefit of LAAC in frail and multi-morbid patients not eligible for OAC at increased peri- and post-procedural complications requires further study.
9. In addition, controversy exists about the implications of intracardiac thrombus risk in operated patients, incidence of peri-device leak, and appropriate therapies required in order to prevent post-procedural thromboembolic events.
10. Finally, data of several currently ongoing randomized controlled trials comparing catheter-based LAAC with best medical care (including non-vitamin K antagonist OACs) in an AF population with high or lower risk for bleeding and for novel indications will further define optimal patient selection and the future role of catheter-based LAAC.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Atrial Appendage, Atrial Fibrillation

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