The case of stroke prevention by left atrial appendage occlusion in patients with atrial fibrillation—can we close the file?

Atrial fibrillation (AF) is the most common arrhythmia and the prevalence is increasing. Future projections predict at least a doubling of AF patients by the year 2050 (1). One of the most devastating consequences of AF is stroke. The presence of AF increases the risk for thromboembolic complications 5-fold and strokes associated with AF have increased morbidity and mortality (2). For this reason stroke risk stratification and appropriate treatment in each patient with AF is of utmost importance. The last decade, the antithrombotic treatment of AF has changed significantly. Easy to use risk scores such as CHADS2 and CHA2DS2-VASc have facilitated the use of antithrombotic agents (3). In addition, with the introduction of direct thrombin inhibitors and factor Xa inhibitors, an alternative to warfarin is available, which is at least as effective as warfarin, but with a lower incidence of intracranial bleeding (4).