The Closing Argument for Surgical Left Atrial Appendage Occlusion

It is widely accepted that the increased risk of stroke among patients with atrial fibrillation is substantially due to embolization of thrombi that develop in the left atrial appendage. On the basis of multiple randomized trials showing that the risk of stroke is reduced with oral anticoagulation therapy among high-risk patients with nonvalvular atrial fibrillation, clinical practice guidelines provide the strongest level of recommendation for oral anticoagulation in these patients, as guided by CHA2DS2-VASc1,2 or CHADS-653 risk scores. In comparison with the robust data that underlie the recommendation for oral anticoagulation, the strategy of percutaneous occlusion of the left atrial . . .