Review on Future Targets and Current Trends in Transcatheter Left Atrial Appendage Closure

Purpose of ReviewAtrial fibrillation is cause for a growing burden of thromboembolic stroke. Transcatheter left atrial appendage closure is an alternative to lifelong oral anticoagulation for many patients with nonvalvular atrial fibrillation. Reviewed here are three commonly used devices (Watchman, Amplatzer Cardiac Plug/Amulet, and Lariat) and their key clinical trials, special candidate patient populations, and recent investigations of the impact of post-procedure antithrombotic strategies.Recent FindingsTranscatheter left atrial appendage closure devices provide noninferior thromboembolic stroke risk reduction and superior bleeding risk reduction compared with oral anticoagulation in nonvalvular atrial fibrillation. Very recent studies of post-procedure antithrombotic regimens describe a variety of anticoagulant and antiplatelet pharmacotherapies without clear impact on device-associated thrombus or post-procedure embolic stroke though more study is needed.SummaryTranscatheter left atrial appendage closure is a viable alternative to lifelong oral anticoagulation to decrease thromboembolism and bleeding in patients with nonvalvular atrial fibrillation who are at increased risk of adverse event with anticoagulants. Patient populations at risk of bleeding on anticoagulants have been demonstrated to benefit from this technology, but there are several additional benefits of left atrial appendage closure unrelated to bleeding risks for specific patient populations. Data on the optimal short-term (weeks to months) post-procedure antithrombotic regimens is emerging and will play a significant role in how to best treat patients and which patients will benefit most from left atrial appendage closure.