Percutaneous left atrial appendage occlusion discrepancy between randomised trials and clinical practice

In patients with atrial fibrillation and previous episodes of bleeding on oral anticoagulant treatment, left atrial appendage occlusion (LAAO) has emerged as an alternative way to decrease the risk of stroke. The use of the procedure has been on the rise, and the news coverage has been dominated by an uncritical acceptance of the benefit of this procedure, which probably have contributed to the increasing number of procedures. This commentary is a presentation and critical appraisal of the available evidence on the efficacy and safety of left atrial appendage closure as stroke prophylaxis. We illustrate that LAAO is supported by limited randomised data risk of serious complications, which we do not believe supports the current widespread use.