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In Japan, LAAC was introduced in 2019 and has been performed in more than 10,000 cases a0s of 2025. Although indications remain limited to high-risk patients with OAC contraindications, procedural volume continues to rise. This review outlines the current status, remaining challenges, and future perspectives of LAAC, with emphasis on the WATCHMAN device. The WATCHMAN FLX and FLX Pro have enhanced procedural safety, sealing efficacy, and anatomical adaptability. Large clinical trials and registries have confirmed stroke prevention efficacy comparable to OAC with fewer hemorrhagic complications. However, device-related thrombus (DRT) and peri-device leak (PDL) remain major concerns, underscoring the need to optimize postprocedural antithrombotic therapy. The Amulet device provides superior ostial sealing through its dual-disk design but is technically more complex and associated with higher procedural complication rates. Intracardiac echocardiography (ICE) has emerged as a less invasive alternative to transesophageal echocardiography, reducing anesthesia requirements and enabling same-session LAAC with AF ablation. The development of pulsed field ablation (PFA) further improves the feasibility of such integrated approaches. Future priorities include risk stratification for DRT, individualized antithrombotic strategies, and broader indications encompassing OAC-resistant embolic stroke and other high-risk populations. With advancing technology, ICE-guided, minimally invasive workflows and integrated ablation\u2013occlusion procedures are expected to establish LAAC as a key component of comprehensive AF management.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s12928-025-01222-6","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T14:37:20Z","timestamp":1765463840000},"page":"292-304","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Left atrial appendage closure: Current status, unresolved issues, and future perspectives"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4985-6929","authenticated-orcid":false,"given":"Yusuke","family":"Kondo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoko","family":"Ryuzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyo","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshio","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"1222_CR1","doi-asserted-by":"publisher","unstructured":"Ogawa H, et al. 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Dr. Kondo received lecture fees from Daiichi-Sankyo, Bayer, Abbott Medical Japan, Biotronik Japan, Boston Scientific, Japan Lifeline, Medtronic, and research funds from Daiichi-Sankyo and Boston Scientific. Dr. Ryuzaki belongs to the endowed department from Medtronic Japan. Dr. Nakano belongs to the endowed department from Abbott Medical Japan, Biotronik Japan and Fukuda Denshi. Dr. Kobayashi received lecture fees from Abbott Medical Japan, Bayer Japan, Bristol-Myers Squibb, Boehringer Ingelheim, and Daiichi-Sankyo, and scholarship funds from Takeda Pharmaceutical, Abbott Medical Japan, Terumo, Otsuka Pharmaceutical, Boehringer Ingelheim, Astellas, Daiichi-Sankyo, Win International, Japan Lifeline, and Nipro. Dr. Kobayashi is the Editor-in-Chief of Cardiovascular Intervention and Therapeutics.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}