Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation, Second Thoughts?

Life expectancy of the population is steadily increasing world wide. Consequently, the incidence and ultimately the prevalence of atrial fibrillation (AF) and it's sequelae will be rising proportionately. It is estimated that 3-5% of persons above 65 years of age have chronic AF, 30% of which will suffer at least one stroke. On the other hand, chronic AF is responsible for about 20% of all cerebrovascular accidents. Predictors of stroke in AF have been defined by the CHADS2 score, and in these patients, oral anticoagulation has been the cornerstone of thromboembolic disease prevention. Because elderly patients have an increased risk of bleeding complications even under the newer antagonists of Factor Xa and direct Thrombin inhibitors, percutaneous occlusion of the left atrial appendage (LAA) as the main thrombogenic source offers an attractive alternative to permanent anticoagulation. This promising new therapeutic approach is put into clinical real world perspective.