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Brain & Heart

REVIEW ARTICLE
Left atrial appendage occlusion: Contemporary

review and current challenges

Mihir V. Odak* , Chamaka Kalutota, Steven Douedi , Zachary Estep ,
Andrew Josephson, Gin Chang , Chunguang Chen, and Daniel S. Ice
Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, New Jersey, United
States of America
(This article belongs to the Special Issue: Structural Heart Disease: Recent Updates)

Abstract

Atrial fibrillation-related stroke is associated with significant morbidity. Historically,
oral anticoagulation has been the mainstay of risk reduction of thromboembolic
events in atrial fibrillation. Oral anticoagulation for stroke prevention, while
effective, has its challenges with increased bleeding risks. Percutaneous closure of
the left atrial appendage (LAA) has emerged as a studied, proven, and Food and
Drug Administration-approved alternative treatment for atrial fibrillation-related
stroke prevention. Nuances to device technology and design have made LAA
occlusion (LAAC) a promising area of thromboembolic protection for patients with
atrial fibrillation. Cardiovascular imaging is the backbone of LAAC, and imaging
techniques have been refined in recent years to supplement procedure planning,
*Corresponding author:
Mihir Odak reduce invasiveness, minimize complications, and, in general, optimize procedural
(mihir.odak@gmail.com) success. In this review, we assess the role of LAAC and its efficacy. We also review
Citation: Odak MV, Kalutota C, the indications for LAAC and, in doing so, identify key patient populations that
Douedi S, et al. Left atrial benefit from this procedure. In addition, we evaluate imaging modalities that are
appendage occlusion: currently used for the procedure and discuss the current challenges related to these
Contemporary review and current
challenges. Brain & Heart. percutaneous devices in reducing the embolic risk. As there are several devices on
2025;3(3):4016. the market for LAAC, we also review the devices available for implantation. Our
doi: 10.36922/bh.4016 hope in offering this review of LAA closure literature is to increase awareness of this
Received: June 21, 2024 procedure, highlight its benefits and safety profile, and emphasize the further need
for more data on the use of these devices in key patient populations.
1st revised: November 5, 2024
2nd revised: December 30, 2024
Keywords: Left atrial appendage; Atrial fibrillation; Thromboembolism; Anticoagulation;
Accepted: January 8, 2025 Cardiovascular imaging
Published online: July 14, 2025
Copyright: © 2025 Author(s).
This is an Open-Access article
distributed under the terms of the 1. Introduction
Creative Commons Attribution
License, permitting distribution, Atrial fibrillation is an arrhythmic condition with significant associated morbidity.
and reproduction in any medium, The global burden of disease projects up to 46 million people worldwide to be afflicted
provided the original work is
1
properly cited. with atrial fibrillation, which is a 33% increase over the last 20 years. This prevalence,
particularly among societies with high socioeconomic status, is expected to increase
Publisher’s Note: AccScience 1
Publishing remains neutral with dramatically in the decades to come.
regard to jurisdictional claims in Although symptoms associated with atrial fibrillation may vary, sequelae of this
published maps and institutional
affiliations. arrhythmia, such as stroke, can be hazardous and significantly impact the quality of life

Volume 3 Issue 3 (2025) 1 doi: 10.36922/bh.4016