Left atrial appendage occlusion: Contemporary review and current challenges

Atrial fibrillation-related stroke is associated with significant morbidity. Historically, oral anticoagulation has been the mainstay of risk reduction of thromboembolic events in atrial fibrillation. Oral anticoagulation for stroke prevention, while effective, has its challenges with increased bleeding risks. Percutaneous closure of the left atrial appendage (LAA) has emerged as a studied, proven, and Food and Drug Administration-approved alternative treatment for atrial fibrillation-related stroke prevention. Nuances to device technology and design have made LAA occlusion (LAAC) a promising area of thromboembolic protection for patients with atrial fibrillation. Cardiovascular imaging is the backbone of LAAC, and imaging techniques have been refined in recent years to supplement procedure planning, reduce invasiveness, minimize complications, and, in general, optimize procedural success. In this review, we assess the role of LAAC and its efficacy. We also review the indications for LAAC and, in doing so, identify key patient populations that benefit from this procedure. In addition, we evaluate imaging modalities that are currently used for the procedure and discuss the current challenges related to these percutaneous devices in reducing the embolic risk. As there are several devices on the market for LAAC, we also review the devices available for implantation. Our hope in offering this review of LAA closure literature is to increase awareness of this procedure, highlight its benefits and safety profile, and emphasize the further need for more data on the use of these devices in key patient populations.