ABSTRACT
Atrial fibrillation significantly increases the risk of stroke. Oral anticoagulation substantially reduces the risk of stroke in patients with atrial fibrillation, but it is associated with a significant risk for haemorrhagic complications. In non-valvular atrial fibrillation, around 90% of cardiac thrombi arise from the left atrial appendage. Occlusion of left atrial appendage has therefore emerged as a therapeutic modality to reduce the risk of systemic thromboembolism in atrial fibrillation. Historically, left atrial appendage occlusion was performed surgically with concomitant coronary artery bypass grafting surgery. In the last decade, however, percutaneous transcatheter techniques have become available. Several devices have been tested and used in humans, but the two devices most commonly used worldwide currently are the Watchman device (Boston Scientific, Natick, MA, USA) and the Amplatzer Plug (St. Jude Medical, St. Paul, MN, USA). The Watchman is the only device to have been tested in randomized clinical trials, and has demonstrated non-inferiority compared to warfarin with respect to several clinical outcomes. This chapter describes the current status of left atrial appendage occlusion devices
