Percutaneous atrial appendage closure. Effective and safe stroke prophylaxis in non-valvular atrial fibrillation

Background. Many patients with atrial fibrillation do not receive an appropriate stroke prophylaxis or are not treated ideally with the currently available anticoagulant agents. Objectives. To show current evidence of percutaneous left atrial appendage (LAA) closure as an alternative to oral anticoagulation. Material and methods. Analysis of recent trials evaluating transcatheter closure devices of the LAA. Results. The most widely used systems for LAA closure are the WATCHMAN (TM) occluder and the Amplatzer Cardiac Plug (TM) (ACP). Most data are available for the WATCHMAN (TM) device. The initial PROTECT-AF trial showed superiority (i.e. composite endpoint of stroke, embolism and cardiovascular death) of the WATCHMAN (TM) compared to warfarin. Also, all-cause mortality was reduced with the WATCHMAN (TM) treatment as compared to warfarin (relative risk reduction 34%). In terms of safety there was no inferiority to warfarin. The ACP system showed comparable results in a number of smaller trials. A ran-domized controlled study comparing the ACP with warfarin and dabigatran is ongoing. Conclusion. Percutaneous LAA closure is a safe and effective alternative to oral anticoagulation. Currently, the technique is used mainly in patients with contraindications for oral anticoagulation. Due to the superiority to warfarin, which was found in recent trials an extended use of transcatheter LAA closure is to be expected.