Nonpharmacologic stroke prevention in atrial fibrillation

Atrial fibrillation is associated with significant mortality and morbidity. The burden of morbidity in atrial fibrillation is mostly due to stroke, one of the major causes of death and the leading cause of long-term disability. Although highly effective in prevention of thromboembolic stroke, several factors limit utilization of chronic oral anticoagulation therapy. Eradication of atrial fibrillation and restoration of effective atrial contraction by surgical methods, or recently, by percutaneous catheter ablation methods, are two attractive approaches for stroke prophylaxis. Surgical exclusion of the left atrial appendage has generated considerable interest in the past decades and it is now performed routinely during mitral valve surgery in many centers. Recently, minimally invasive and percutaneous methods for the exclusion of left atrial appendage have been introduced. Currently, these approaches are being evaluated in ongoing trials. This review will discuss the current status of nonpharmacologic methods in the prevention of stroke in atrial fibrillation.