{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T13:46:42Z","timestamp":1776260802880,"version":"3.50.1"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Atrial fibrillation (AF) affects approximately 3%\u20135% of adults and is projected to double in prevalence by 2060, significantly increasing the burden of thromboembolic stroke. This risk is largely attributed to thrombus formation within the left atrial appendage (LAA), particularly in nonvalvular AF, where the LAA's trabeculated anatomy, diverse morphologies (e.g., chicken wing, windsock, cactus, cauliflower), and impaired contractility allows for blood stasis and thrombogenesis. As a result, the LAA has become a focus for stroke prevention strategies. This review demonstrates current evidence on LAA closure by discussing patient selection, anatomical feasibility, procedural workflow, imaging guidance (transesophageal echocardiography vs. intracardiac echocardiography), device platforms (Amplatzer Amulet, Watchman 2.5, Watchman FLX\/FLX Pro), and complication profiles. P procedural success rates exceed 95%, with improving safety profiles. Nonetheless, adverse events such as pericardial effusion, device-related thrombus (DRT), peri-device leak (PDL), device embolization, and periprocedural stroke remain important considerations. Post-implant antithrombotic strategies are evolving beyond the traditional warfarin\/aspirin \u2192 DAPT \u2192 SAPT pathway toward more individualized regimens, including simplified DOAC or antiplatelet-based approaches tailored to bleeding and thrombotic risk especially in complex scenarios like concurrent coronary stenting. Ongoing device innovations (e.g., FLX Pro, expanded size matrices, thromboresistant coatings), CT-led surveillance algorithms, and randomized studies of post-implant pharmacotherapy aim to reduce DRT\/bleeding, harmonize follow-up, and expand indications. Collectively, these advances refine patient-centered LAA closure by aligning anatomic complexity, procedural technique, and pharmacology to improve stroke prevention and safety in AF.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1767568","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:50:32Z","timestamp":1776257432000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Left atrial appendage closure devices: a contemporary review of techniques, tips and tricks"],"prefix":"10.3389","volume":"13","author":[{"given":"Kamran","family":"Namjouyan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Geisinger Medical Center","place":["Danville, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafeez Ul","family":"Hassan Virk","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Disease, Department of Medicine, Albert Einstein Healthcare Network","place":["Philadelphia, PA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Affan","family":"Rizwan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Baylor College of Medicine","place":["Houston, TX, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muzamil","family":"Khawaja","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Emory University","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahboob","family":"Alam","sequence":"additional","affiliation":[{"name":"Texas Heart Institute and Baylor College of Medicine","place":["Houston, TX, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Cardiology I- Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol","place":["Muenster, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chayakrit","family":"Krittanawong","sequence":"additional","affiliation":[{"name":"HumanX","place":["Delaware City, DE, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1111\/joim.13217","article-title":"Large-scale screening studies for atrial fibrillation\u2014is it worth the effort?","volume":"289","author":"Engdahl","year":"2021","journal-title":"J Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1016\/j.jacc.2024.07.014","article-title":"Minimum national prevalence of diagnosed atrial fibrillation inferred from California acute care facilities","volume":"84","author":"Noubiap","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1212\/WNL.0b013e3182a2cc15","article-title":"Association of atrial fibrillation with mortality and disability after ischemic stroke","volume":"81","author":"McGrath","year":"2013","journal-title":"Neurology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1016\/j.jcmg.2014.08.009","article-title":"The left atrial appendage: anatomy, function, and noninvasive evaluation","volume":"7","author":"Beigel","year":"2014","journal-title":"JACC Cardiovasc Imaging"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/europace\/euz212","article-title":"The left atrial appendage in humans: structure, physiology, and pathogenesis","volume":"22","author":"Karim","year":"2020","journal-title":"Europace"},{"key":"B6","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1136\/hrt.82.5.547","article-title":"Left atrial appendage: structure, function, and role in thromboembolism","volume":"82","author":"Al-Saady","year":"1999","journal-title":"Heart"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1161\/STROKEAHA.124.043867","article-title":"Left atrial appendage occlusion and its role in stroke prevention","volume":"56","author":"Seiffge","year":"2025","journal-title":"Stroke"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1016\/s0894-7317(99)70105-7","article-title":"Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. 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