Update on left atrial appendage closure for neurologists

A significant proportion of patients with atrial fibrillation (AF) who need thromboembolic protection are not treated with or discontinue oral anticoagulation after its initiation. Undertreatment in clinical practice has not improved sufficiently despite the availability of direct oral anticoagulants, which are associated with less intracranial bleeding than vitamin K antagonists. Multiple reasons account for this phenomenon, including bleeding events or ischemic strokes while on anticoagulation, poor treatment adherence despite best educational attempts, or aversion to drug therapy. Percutaneous left atrial appendage (LAA) closure was introduced as an alternative to pharmacological therapy in AF patients in the early 2000s. Due to significant improvements in procedural safety over the years, left atrial appendage closure (LAAC), predominantly achieved through a percutaneous catheter-based device implantation approach, is increasingly favoured for preventing thromboembolic events in patients who cannot achieve effective anticoagulation or have a high hemorrhagic risk. This focused summary and update of a recently published practical guide, developed within guideline/guidance boundaries, provides a perspective of current evidence of potential indications, benefits, complications and limitations of LAAC for neurologists and stroke physicians who may consider this increasingly utilised therapy.