Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice

Prophylactic left atrial appendage occlusion has been suggested as a means of cardioembolism risk reduction in patients with atrial fibrillation. Its clinical benefits have been discussed together with potential endocrine or hemodynamic adverse effects, providing conflicting resolutions. We aimed to provide a thorough overview of the current literature and a recommendation for daily clinical decision making. A comprehensive Medline search through PubMed was utilized to search for relevant articles, further filtered by the title and abstract. Sixty-five articles were selected as relevant for the topic. Concomitant left atrial appendage occlusion during cardiac surgery for other reason is effective in terms of thromboembolism risk reduction in patients with history of atrial fibrillation and higher CHA2DS2-VASc score. Surgical occlusion is safe, epicardial closure techniques are preferred. Thoracoscopic and transcatheter techniques are also feasible and the individual treatment choice must be tailored to the patient. The concerns about endocrine disbalance or risk of heart failure after occlusion are not supported by evidence. Current evidence is conflicting with regard to any hemodynamic consequences of appendage occlusion.