Effectiveness and safety of transcatheter left atrial appendage closure.

Atrial fibrillation (AF) is responsible for cardiogenic stroke. Since left atrial appendage (LAA) is a cause of most of cardiac thrombus, LAA closure is an emerging novel stroke prevention procedure for patients with AF alternative to anticoagulation. WATCHMAN LAA Closure device (Boston Scientific, Marlborough, MA, USA) is the only approved device in the USA and Japan. The device is indicated in high bleeding risk and high stroke risk non-valvular AF patients. Cardiac tamponade, stroke, and device embolization are typical procedural complications. Procedural complication rate is reduced with implanters' experience and matured procedure steps. Several randomized trials demonstrated procedure safety and efficacy of the device. The device resulted in similar thromboembolic event rates but significantly reduced bleeding events compared to anticoagulants. After the procedure, optimal post procedural antithrombotic drug regimen has not been fully investigated. Also, device-related thrombosis can be a new issue. Modification of the device can improve issues, but not fully solve it. Tailor made treatment based on the individual risk by heart team communication with neurologists is essential to treat patients.