Left atrial appendage devices for stroke prevention in atrial fibrillation

Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, and stroke prevention remains an integral part of management of AF. Long-term therapy with oral anticoagulants, though effective, has many limitations, and these limitations have encouraged the search for device-based alternatives. In patients with non-valvular AF, approximately 90 % of thrombi are thought to arise from the left atrial appendage (LAA). The LAA can be obliterated surgically or percutaneously, and this should reduce the incidence of systemic thromboembolic events in AF, ideally without the need for further anticoagulation. We explore the currently available LAA occlusion devices and the evidence behind these devices. Although additional evidence from randomized trials is required to fully characterize the safety and efficacy of all of these devices, LAA occlusion has the potential to offer an attractive alternative for those at high stroke risk but are under-protected because of contraindications to anticoagulant therapy.