Left atrial appendage closure (LAAO) is a catheter-based procedure used in selected patients with atrial fibrillation when a specialist team considers mechanical closure of the appendage as an alternative stroke-prevention strategy. It is not a routine replacement for anticoagulation and requires individualized assessment of thromboembolic risk, bleeding risk, anatomy and medication history.
Why the anticoagulation history matters
The referral question usually includes why long-term oral anticoagulation is unsuitable, difficult or associated with important bleeding risk. A structural-heart team needs the actual clinical history rather than only a request for a device.
Records that help the review
Send enough evidence to assess both atrial fibrillation and bleeding/stroke risk.
- ECG or rhythm documentation of atrial fibrillation
- History of stroke or systemic embolism
- Major bleeding history
- Current and previous anticoagulants
- Echocardiography
- Relevant CT or transesophageal echo if already performed
- Kidney function and other major comorbidities
Anatomy and imaging are part of the decision
The appendage anatomy, thrombus exclusion and procedural access have to be assessed before implantation. The exact imaging pathway depends on the center and patient.
Post-procedure medication still needs a plan
Closure does not mean that all antithrombotic medication stops immediately. Ask the center what medication is expected after the procedure and which follow-up imaging must be completed before treatment is changed.
Sources and review
This guide was last source-reviewed on 2026-08-29.