[Interventional stroke prophylaxis : endocardial and epicardial left atrial appendage closure]

Atrial fibrillation (AF) is currently one of the major causes of ischemic stroke with an estimated stroke risk of 5% per year. Oral anticoagulation is an effective treatment for the reduction of stroke risk in patients with AF but is also associated with an increased risk of bleeding. In patients with AF it has been shown that left atrial thrombi can be identified within the left atrial appendage (LAA) in more than 90% of cases. On the basis of these findings LAA closure devices have been developed as an alternative to oral anticoagulation. Besides endocardial LAA occluders, such as the WATCHMAN™ and AMPLATZER™ devices, an epicardial LAA occluder (LARIAT™) has recently been introduced. The following review introduces the various endocardial and epicardial LAA closure devices and assesses the indications, management, advantages and disadvantages of the two approaches according to the current literature.