Left atrial appendage occlusion: behind the bleeding risk

Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with an increased risk of embolic stroke. The main prevention strategy for cerebral embolic events is based on the use of oral anticoagulant therapy (OAT). Left atrial appendage occlusion (LAAO) has demonstrated non-inferiority to OAT in clinical trials for prevention of stroke in non-valvular atrial fibrillation (NVAF). Patients with NVAF may still suffer ischemic strokes despite receiving adequate OAT.The physiopathological substrate remains unclear and only few theories can be proposed to explain the phenomenon and the approach to secondary prevention in these 'resistant strokes' remains largely empirical.Several therapeutic strategies have been proposed. Among these, LAAO should be taken into consideration. The procedure requires special planning in well selected patients, but can be performed successfully in most cases.