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Updated: Jun 18, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Practical guide on left atrial appendage closure for the non-implanting physician: an international consensus paper
Tatjana Potpara1,2, Marek Grygier3, Karl Georg Häusler4
1Medical Faculty, University of Belgrade, Belgrade, Serbia.
Insights
Left atrial appendage closure is an effective alternative for patients with atrial fibrillation (AF) who cannot tolerate oral anticoagulation. This minimally invasive procedure offers stroke prevention without long-term bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Many patients with atrial fibrillation (AF) are undertreated with oral anticoagulation due to bleeding risks, poor compliance, or drug aversion.
- Direct oral anticoagulants have not fully resolved the issue of undertreatment despite improved safety profiles.
- An alternative, interventional therapy has been available for over 20 years.
Purpose of the Study:
- To introduce left atrial appendage closure (LAAC) as an alternative therapy for thromboembolic prevention in AF patients.
- To explain the devices and implantation techniques for LAAC.
- To guide non-implanting physicians on patient selection and referral for LAAC.
Main Methods:
- Review of existing literature and guidelines on LAAC.
- Description of catheter-based device implantation for LAAC.
- Explanation of indications and follow-up protocols for LAAC.
Main Results:
- LAAC is an effective and safe alternative to oral anticoagulation for stroke prevention in specific AF patient populations.
- Improvements in procedural safety have made LAAC increasingly favored.
- LAAC is associated with reduced long-term bleeding risks compared to anticoagulation.
Conclusions:
- LAAC is a viable and increasingly popular option for thromboembolic event prevention in AF patients unsuitable for oral anticoagulation.
- Wider appreciation of LAAC among cardiologists and internists is needed.
- This guide aims to facilitate appropriate patient referral for LAAC consideration.
Abstract:
A significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years, left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with AF. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.
