Left Atrial Appendage Closure: What the Evidence Does and Does Not Reveal-A View from the Outside.

This review summarizes the evidence for left atrial appendage closure (LAAC) as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. LAAC reduces hemorrhagic stroke and mortality versus warfarin, but is inferior for ischemic stroke reduction based on randomized data. Whilst a feasible treatment in OAC-ineligible patients, questions remain over procedural safety, and the improvement in complications observed in nonrandomized registries is uncorroborated by contemporary randomized trials. Management of device-related thrombus and peridevice leak remain unclear, and robust randomized data versus direct OACs are required before recommendations can be made for widespread adoption in OAC-eligible populations.
Competing Interests: Disclosure K. Saraf has received research funding from Boston Scientific. G.M. Morris has received research funding and honoraria from Boston Scientific and Medtronic, honoraria from Biosense Webster.
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