Imaging for Percutaneous Left Atrial Appendage Closure: A Contemporary Review

Embolic stroke is the most significant complication of atrial fibrillation (AF). Oral anticoagulation (OAC) agents have an established role to prevent stroke in patients with AF. However, in patients who have near-fatal bleeding events during treatment with OAC, alternative, non-pharmacological methods of stroke prevention are needed. The left atrial appendage (LAA) is the most common source of thrombi in AF and recently, mechanical, percutaneous occlusion of the LAA has emerged as an effective strategy for stroke prophylaxis in patients deemed high risk for OAC-related bleeding. Although percutaneous LAA occlusion offers a significant step forward in AF stroke risk prevention, the procedural risks are not trivial and include device leakage, embolization, cardiac perforation, tamponade, and death. To minimize these risks and improve LAA occlusion outcomes, optimal peri-procedural imaging is critical to ensure accurate sizing and safe implantation. In this review of LAA occlusion, we present the current, clinically used percutaneous devices and provide a focused review of the latest imaging approaches used for evaluation of the LAA before, during, and after occlusion.