Percutaneous closure of the left atrial appendage for stroke prevention

Atrial fibrillation (AF) is the most common arrhythmic disorder and is a common cause of stroke. Anticoagulation is the mainstay for stroke prophylaxis in these patients. However, there are a large percentage of patients who do not take anticoagulation due to contraindications, ranging up to 20%. As previous studies have shown that >90% of the thrombi in AF come from the left atrial appendage (LAA), LAA closure is an attractive alternative to anticoagulation in this patient population. Percutaneous closure of the LAA has been performed successfully and safely with a large number of devices. Watchman device (Boston Scientific) has been the most extensively studied in randomized clinical trials, showing a significant reduction in rate of hemorrhagic stroke and CV death as compared to warfarin alone. This chapter discusses the rationale of LAA closure, description of available and emerging percutaneous LAA closure devices, and preprocedural, procedural, and postprocedural aspects of Watchman device implantation.