Left Atrial Appendage Closure for Stroke Prevention

Atrial fibrillation is the most common chronic arrhythmia worldwide, and stroke is its most common complication. Approximately 20% of all ischemic strokes attributed to atrial fibrillation. Left atrial appendage thrombi are 90% responsible for embolic strokes in patients with non-valvular atrial fibrillation. In patients with atrial fibrillation, systemic anticoagulation is highly effective in lowering the risk of stroke. Bleeding problems and non-adherence hamper adequate anticoagulation therapy. As an alternative to stroke prevention with medical treatment, left atrial appendage closure is feasible and has proven to be an alternative to anticoagulation in non-valvular atrial fibrillation patients. Various left atrial appendage closure methods and devices have been defined and applied surgically and percutaneously. Exclusion of the left atrial appendage potentially minimizes the risk of embolic stroke and may eliminate chronic anticoagulation requirements. This chapter reviews left atrial appendage closure for stroke prevention in non-valvular atrial fibrillation.