Indications, evidence, and controversy in the closure of the left atrial appendage

Closure of the left atrial appendage (LAAO) represents a valid option for the prevention of cardio-embolic stroke in patients with atrial fibrillation (AF) at high bleeding risk. Previous studies had shown that the atrial appendage represents the site of atrial thrombus formation in about 90% of cases in the presence of non-valvular AF. In all patients with AF and higher thromboembolic risk (in particular with CHA2DS2VASc score >= 2 in women and >= 1 in men) there is an indication for thromboembolic prophylaxis with AOC (oral anti-coagulants). The main guidelines and international consensus documents place the indication for the LAAO in patients with the need for thromboembolic prophylaxis who have contraindications to oral anticoagulant therapy (class of recommendation IIb).

Automated summary

Closure of the left atrial appendage (LAAO) is a valid option for high bleeding risk atrial fibrillation (AF) patients to prevent cardio-embolic stroke. Previous studies have shown that the atrial appendage is the site of atrial thrombus formation in about 90% of cases in non-valvular AF. All AF patients with higher thromboembolic risk (especially women with CHA2DS2VASc score >= 2, men >= 1) should receive thromboembolic prophylaxis with oral anticoagulants.