Left atrial appendage exclusion

Surgical left atrial appendage (LAA) exclusion has been performed for many decades as part of cardiac surgical procedures like mitral valve surgery. This chapter provides an overview of catheter-based devices that are currently available or being investigated for LAA exclusion. Most of these are designed to obstruct the LAA orifice mechanically from the endocardial aspect. The Lariat procedure, however, uses a combined endo-epicardial access to suture ligate the base of the LAA from its epicardial aspect. The chapter includes a general description of implant technique, procedural tips, and post-implantation of the Watchman and Amplatzer Cardiac Plug (ACP) devices. The Watchman was approved for clinical use in the USA on the basis of continued use of warfarin after device implantation and the above protocols are followed in clinical practice. The ACP devices have a low thrombogenicity profile and 6 months of dual antiplatelet therapy (DAT) without concomitant oral anticoagulant therapy is thought to be sufficient.