Approaches to Left Atrial Appendage Closure: Device Design, Performance, and Limitations

Up to 6.1 million people in the United States have atrial fibrillation (AF), which is associated with an increased risk of stroke. Oral anticoagulants are the mainstay of stroke prevention in AF. For decades, warfarin was the only available drug, fraught with compliance limitations, a narrow therapeutic window, and a high risk of hemorrhage. Pharmacologic developments have produced new anticoagulants that have improved the rates of stroke related to AF; however, they still confer a high risk of bleeding, making them unsuitable for some patients. Studies have shown that roughly 90% of strokes in patients with AF occur in the left atrial appendage (LAA). This understanding has prompted the development and testing of novel percutaneous strategies for LAA closure as an alternative to anticoagulation therapy. The following review examines the relative merits and shortcomings of these strategies and explores future prospects in the prevention of AF-related stroke.