Peer-review started: September 10, 2014
First decision: October 14, 2014
Revised: October 26, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: February 26, 2015
Processing time: 155 Days and 5.3 Hours
Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
Core tip: Left atrial appendage (LAA)-Occlusion was developed as an alternative to chronic anticoagulation therapy in patients with nonvalvular atrial fibrillation. In two large randomized trials the principal concept of LAA-occlusion has been demonstrated to be noninferior to coumadine therapy, in longterm follow up being even superior to oral anticoagulation in terms of efficacy and some safety issues like bleeding complications. However the procedure is complex and knowledge of nature, management and prevention of complications should minimize the risk of the procedure and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.