Close the appendage, open the future

Left atrial appendage closure is a proven method for prevention against stroke in patients with non-valvular atrial fibrilla-tion. This method is proven for having clinical utility as well as safety. The need for coverage in this area is immense. Atrial fibrillation affects 1%–2% of the entire adult population.1 Of all ischae-mic strokes, 15 % are associated with atrial fibrillation. Both the CHADS2 and the CHA2DS2-VASc risk scores have been used for determining the level of anticoagulation in these patients. Multiple anticoagulants have been used for prevention of ischaemic stroke, including warfarin, dabigatran, rivar-oxaban, apixaban and edoxaban. The main purpose of the ‘new ’ oral anticoagulants is to provide anticoagulants without the add-itional need for monitoring. The Amplatzer Cardiac Plug and the second-generation Amulet device have a large history of registry data since the device was first implanted in 2008. The paper by Lopez-Minguez et al2 reports results from 167 patients who were contra-indicated for oral anticoagulation. Procedural success was high at 94.6 % of patients, making the procedure very safe. Stroke was at 2.4 % per year, which con-sisted of a 75 % reduction compared with expected risk. For these patients, anticoagu-lation is not an option. This is in line with other large databases, including the ones mentioned in their table 4. The Canadian registry, which had a higher baseline stroke risk and a similar follow-up period, also showed a similar reduction as well as the