Narrative review examines left atrial appendage closure for stroke prevention in atrial fibrillation.

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Frontiers in Medicine Published April 18, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider refining LAA closure by aligning anatomic complexity, technique, and pharmacology for AF stroke prevention.

This narrative review synthesizes evidence regarding left atrial appendage (LAA) closure for the management of atrial fibrillation. The scope encompasses procedural success, safety profiles, and adverse events such as device-related thrombus, peri-device leak, and device embolization. The authors do not report a specific sample size or follow-up duration for the aggregated data presented.

The review indicates that procedural success rates exceed 95%. Regarding safety, potential adverse events include pericardial effusion, device-related thrombus, peri-device leak, device embolization, and periprocedural stroke. The text does not provide specific rates for serious adverse events, discontinuations, or overall tolerability.

The authors suggest that practice should focus on refining patient-centered LAA closure. This approach involves aligning anatomic complexity, procedural technique, and pharmacology to improve stroke prevention and safety in atrial fibrillation. The review does not establish causal links or provide definitive efficacy comparisons against specific comparator medications beyond general categorization.

Limitations regarding funding, conflicts of interest, and specific study phase details are not reported in this narrative synthesis. Clinicians should interpret these qualitative conclusions with caution, recognizing the lack of quantitative pooled data or randomized trial evidence within this specific source.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

Atrial fibrillation (AF) affects approximately 3%–5% of adults and is projected to double in prevalence by 2060, significantly increasing the burden of thromboembolic stroke. This risk is largely attributed to thrombus formation within the left atrial appendage (LAA), particularly in nonvalvular AF, where the LAA's trabeculated anatomy, diverse morphologies (e.g., chicken wing, windsock, cactus, cauliflower), and impaired contractility allows for blood stasis and thrombogenesis. As a result, the LAA has become a focus for stroke prevention strategies. This review demonstrates current evidence on LAA closure by discussing patient selection, anatomical feasibility, procedural workflow, imaging guidance (transesophageal echocardiography vs. intracardiac echocardiography), device platforms (Amplatzer Amulet, Watchman 2.5, Watchman FLX/FLX Pro), and complication profiles. P procedural success rates exceed 95%, with improving safety profiles. Nonetheless, adverse events such as pericardial effusion, device-related thrombus (DRT), peri-device leak (PDL), device embolization, and periprocedural stroke remain important considerations. Post-implant antithrombotic strategies are evolving beyond the traditional warfarin/aspirin → DAPT → SAPT pathway toward more individualized regimens, including simplified DOAC or antiplatelet-based approaches tailored to bleeding and thrombotic risk especially in complex scenarios like concurrent coronary stenting. Ongoing device innovations (e.g., FLX Pro, expanded size matrices, thromboresistant coatings), CT-led surveillance algorithms, and randomized studies of post-implant pharmacotherapy aim to reduce DRT/bleeding, harmonize follow-up, and expand indications. Collectively, these advances refine patient-centered LAA closure by aligning anatomic complexity, procedural technique, and pharmacology to improve stroke prevention and safety in AF.