Left atrial appendage occlusion for stroke prevention in atrial fibrillation: recent evidence, catheter ablation, and future trials.

INTRODUCTION

Oral anticoagulation (OAC) remains the standard for stroke prevention in atrial fibrillation (AF), but bleeding, non-persistence and thromboembolism despite treatment create important unmet needs. Catheter ablation and left atrial appendage occlusion (LAAO) address distinct mechanisms and do not reproduce systemic anticoagulation.

AREAS COVERED: This narrative review covers randomized anticoagulation-withdrawal studies after ablation, trials and pooled evidence on LAAO, patients unable to sustain anticoagulation, procedural imaging and healing, post-implant antithrombotic therapy, and future trial design. Targeted searches of PubMed/MEDLINE and ClinicalTrials.gov were supplemented by citation screening and review of contemporary congress reports, for evidence spanning 2005-10 October 2026.

EXPERT OPINION: The completed randomized LAAO programme mainly tests substitution where OAC remains feasible. Precision source control should be investigated as rescue when OAC cannot be sustained and as a potential dose-sparing complement in selected patients, while addressing residual ischemic risk and verifying durable closure.