Left atrial appendage occlusion

Atrial fibrillation (AF) affects more than 33 million people worldwide. AF accounts for a majority of cardioembolic strokes, especially in elderly individuals. Although anti-coagulation reduces the risk of embolic stroke, there are a significant proportion of AF patients who have relative or absolute contraindications to anti-coagulation. Imaging studies have previously documented that >90% of embolic strokes in non-valvular AF originate from the left atrial appendage (LAA). This might be secondary to specific anatomy of pectinate muscles as well as inflammation and fibrosis involving the LAA. This therefore makes therapies targeted at LAA occlusion (LAAO) appealing. LAAO using the WATCHMAN device provides an alternative for embolic risk reduction in a large patient population with non-valvular AF who are not suitable candidates for long term anti-coagulation. This chapter will focus on patient selection, pre-procedural planning along with a meticulous intra-procedural approach for LAAO using the WATCHMAN device.