Left Atrial Appendage Occlusion Devices Focused on Complications of Therapy

Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF), especially in patients at high bleeding risk. While generally safe, LAAO involves procedural and postprocedural risks. The most serious complication is pericardial effusion or tamponade; other periprocedural risks include stroke, device embolization, vascular injury, major bleeding, and air embolism. With improved techniques, serious complication rates have declined to under 2%. Ideal candidates for LAAO are patients with nonvalvular AF and elevated CHA₂DS₂-VASc scores who are poor oral anticoagulation candidates due to high HAS-BLED scores or contraindications. Major trials have shown LAAO to be noninferior to warfarin or direct oral anticoagulants in preventing stroke and systemic embolism. A clear understanding of patient selection, procedural safety, and long-term risks is critical to optimizing LAAO outcomes and expanding its role in AF management. This review aimed to discuss the current evidence, indications, outcomes, evidence gaps, and future directions of LAAO devices.