LAAO

LAAO, or Left Atrial Appendage Occlusion, is a medical procedure that aims to prevent stroke in patients with atrial fibrillation by occluding the left atrial appendage, a favored site of thrombus formation in AF. It can be performed percutaneously with transcatheter devices or surgically, either during other heart operations or as a standalone procedure.

In the percutaneous approach, devices such as Watchman, Amplatzer Amulet, and Watchman FLX are implanted at the opening of the left atrial appendage to seal it off. Surgical LAA occlusion uses methods like clipping, stapling, or exclusion during open-heart surgery.

Indications include nonvalvular AF patients at elevated stroke risk who have contraindications to long-term anticoagulation or high bleeding risk. LAAO is considered a reasonable alternative to chronic anticoagulation in selected patients, and guidelines reflect this option in appropriate scenarios.

Evidence from randomized trials PROTECT AF and PREVAIL supported the noninferiority of LAAO to warfarin for stroke prevention, with benefits maintained over time. Real-world experience and newer devices have expanded its use, though long-term outcomes and patient selection continue to evolve.

Post-implant management commonly involves short-term antithrombotic therapy and follow-up imaging to assess device position and leak or device-related thrombus. Potential complications include pericardial effusion, device embolization, residual leaks, thrombus on the device, and infection.

LAAO thus provides an alternative strategy for stroke prevention in select AF patients, particularly those unable to tolerate long-term anticoagulation, with ongoing assessment of risks, benefits, and technique.