Left atrial appendage occlusion: a niche procedure for a niche cohort?

This editorial refers to ‘Left atrial appendage occlusion in the UK; prospective registry and data linkage to hospital episodes statistics, by I. Willits et al. 10.1093/ehjqcco/qcab042. Ischaemic stroke remains the most feared complication of atrial fibrillation (AF). Despite the widespread success of novel oral anticoagulants (NOACs) at mitigating this risk, significant subsets of patients find them unsuitable due to the associated bleeding risk. In this context, left atrial appendage occlusion (LAAO) or excision appears to offer an exciting alternative.1,2 Randomized trials have reported an equivalence of LAAO implantation with NOACs at stroke prevention in high-risk patients, and recent surgical data strongly support a mechanistic benefit in closing off the left atrial appendage and thereby preventing clot formation. Many patients would prefer to be ‘off medication’: a permeant, device-based solution is certainly appealing compared with lifelong daily tablets. However, the application of this technology is limited by an...