A significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years, left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with AF. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.

1st Department of Cardiology Poznan University School of Medical Sciences Poznan Poland

Berlin Institute of Health Center for Regenerative Therapies Berlin Germany

Cardioangiologisches Centrum Bethanien Agaplesion Markus Krankenhaus Frankfurt Germany

Cardioangiology Center Bethanien CCB Frankfurt Germany

Cardiologie Clinique Pasteur Brussels University VUB Brussels Belgium

Cardiology Department St Antonius Hospital Nieuwegein Amsterdam University Medical Centers Amsterdam Netherlands

Cardiology Division Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Policlinico di Modena Modena Italy

Cardiology Heart Rhythm Management Department Clinique Pasteur Toulouse France

Cardiovascular Center Aalst OLV Hospital Aalst Belgium

Center for Vascular Research Munich Germany

Centro Cardiologico Monzino IRCCS Department of Clinical Electrophysiology and Cardiac Pacing Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy

Danish Center for Health Services Research Department of Clinical Medicine Aalborg University Aalborg Denmark

Department of Cardiology Aarhus University Hospital Aarhus Denmark

Department of Cardiology Angiology and Intensive Care Medicine Deutsches Herzzentrum Charité Charité University Medicine Berlin

Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany

Department of Cardiology University Hospital Kralovske Vinohrady Charles University Prague Czech Republic

Department of Neurology Universitätsklinikum Würzburg Würzburg Germany

Department of Surgery Oncology and Gastroenterology University Hospital of Padua Padua Italy

Deutsches Herzzentrum der Charité Campus Virchow Klinikum Berlin Germany

Division of Cardiology European Georges Pompidou Hospital AP HP Paris France

Division of Nephrology Miull General Hospital Acquaviva delle Fonti Italy

EuDial Working Group of the European Renal Association Acquaviva delle Fonti Italy

Genetic and Cardiovascular Sciences Institute Cardiology Academic Group St George's University of London Cranmer Terrace London SW190RE UK

German Centre for Cardiovascular Research partner site Berlin Charité Universitätsmedizin Berlin Germany

German Centre for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany

German Heart Center Charite Campus Mitte Berlin Germany

Ippokrateio Hospital of Thessaloniki Aristotle University of Thessaloniki Thessaloniki Greece

Istituto Auxologico Italiano IRCCS Milan Italy

Leicester NIHR BRU University of Leicester Glenfield Hospital Leicester UK

Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital Liverpool UK

Medical Faculty University of Belgrade Belgrade Serbia

Nephrology and Dialysis Unit ASL Toscana NordOvest Livorno Italy

Ospedale del Cuore Fondazione CNR Regione Toscana G Monasterio Pisa Italy

School of Medicine and Surgery University of Milano Bicocca Nephrology Clinic Monza Italy

Structural and Congenital Heart Disease European Interbalkan Medical Centre Thessaloniki Greece

University Clinical Centre of Serbia Belgrade Serbia

Comment In

J Nephrol. 2024 Jun;37(5):1197-1200. doi: 10.1007/s40620-024-01944-5. PubMed

Erratum In

Europace. 2024 May 2;26(5):euae142. doi: 10.1093/europace/euae142. PubMed

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