Left atrial appendage closure

Atrial fibrillation is associated with a significant stroke risk. Though anticoagulation with warfarin reduces this risk, it also increases the likelihood of bleeding including intracranial hemorrhage and requires meticulous patient compliance and monitoring. Alternative anticoagulants have recently been demonstrated to be at least equivalent to warfarin but are accompanied by a similar bleeding risk. Therefore, the concept of percutaneous left atrial appendage closure has been pursued and, most recently, at least equivalency to anticoagulation was reported in a randomized trial comparing it to conventional anticoagulation with warfarin. This chapter outlines important technical considerations for implantation of a left atrial appendage occlusion device including the currently available WATCHMAN® device (Atritech Inc. Minneapolis, MN, USA) and Amplatzer® Cardiac Plug (AGA Medical Corporation, Minneapolis, MN, USA). It includes important tips regarding imaging, placement, and postprocedural care and outlines future perspectives for the concept of percutaneous left atrial appendage closure.