Left Atrial Appendage Closure Lacks Sufficient Evidence for Routine Use

Percutaneous left atrial appendage occlusion (pLAAO) is increasingly being adopted as an alternative to non-vitamin K antagonist oral anticoagulants (NOACs) for patients with atrial fibrillation. However, the current evidence does not justify this enthusiasm. Key limitations include wide non-inferiority margins in some of the trials, inclusion of components in the primary efficacy endpoint that are not directly influenced by pLAAO, making non-inferiority easier to achieve, limited statistical power to detect differences in ischemic stroke or systemic embolism, and an overstated bleeding advantage.