title: Left atrial appendage closure for stroke prevention in non-valvular atrial fibrillation: rationale, devices in clinical development and insights into implantation techniques.
abstract: OBJECTIVE
  In patients with atrial fibrillation, a relevant stroke risk (CHA2DS2-VASc score ≥2) and a relative or absolute contraindication for oral anticoagulation, catheter-based LAA occlusion is performed increasingly in Europe. The present article summarises the rationale, clinical data, devices, implantation techniques and follow-up drug regimens.
  
  
  RESULTS
  European survey data on patients with atrial fibrillation support the need for non-pharmacological approaches for stroke prevention in patients with atrial fibrillation. A relevant bleeding risk remains with novel oral anticoagulants (NOACs), which are also dependent on drug compliance. Recent long-term data from the PROTECT-AF trial and the CAP registry regarding the WATCHMAN LAA occluder device suggest safety and efficacy. First registry data support the safety of two other CE-marked devices, the AMPLATZER Cardiac Plug (ACP) and the Coherex WaveCrest device, which have become available in Europe. Other LAA occlusion devices are in clinical development.
  
  
  CONCLUSIONS
  Catheter-based LAA occlusion is now being developed further as an interventional approach for stroke prevention in patients with atrial fibrillation. Implantation techniques and devices are being improved, which will probably result in better procedural safety. Appropriate operator training is of major importance for this approach.
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bergmann
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods
chemical_list: D000925:Anticoagulants