# Left atrial appendage occlusion Technology · id `cardio:left-atrial-appendage-occlusion` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: LAA closure; Left atrial appendage closure; LAAO Browse, organ or system: Heart Browse, condition area: Stroke; Heart rhythm problems ## In plain language The left atrial appendage is a small pouch off the heart's upper left chamber. Closing it off is meant to stop clots from forming there and causing a stroke. A US government patient page describes this for people who cannot take blood thinners. In the PROTECT AF trial, which enrolled people who were eligible for warfarin, percutaneous closure with a device did not do worse than warfarin for the trial's main outcome, but it had more serious safety events, mostly linked to the procedure. The same page also cautions that complete closure is hard to achieve and that a leak leaves some clotting risk. ## Technical summary MeSH descriptor D000097546 (Left Atrial Appendage Closure). Percutaneous closure was tested in PROTECT AF with one closure device. A US government patient page says surgeons may also deal with the appendage during surgical ablation or other heart surgery. The US approval of the closure device (PMA P130013) is for people who are suitable for warfarin and have a rationale to seek a non-drug alternative; the patient population that page describes (people who cannot take blood thinners) and the population approved in the US label wording are not the same, and the sources read do not reconcile them. ## Claims, with the population each applies to ## Context: Patients with atrial fibrillation (ACC summary of the 2023 guideline) Recipient: Recipient not specified; Population: Patients with atrial fibrillation. The ACC summary gives no age limits and, apart from the exceptions each claim names, no exclusions.; Care setting: Not stated in the ACC summary.; Geography: Not stated in the ACC summary (issued by American societies; jurisdiction not verified); Life stage: Not stated in the ACC summary; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (guideline context) ### An ACC summary of the 2023 ACC/AHA atrial fibrillation guideline says percutaneous left atrial appendage occlusion is reasonable (class 2a) for patients with a CHA2DS2-VASc score of 2 or more who have a medical reason not to take anticoagulants over the long term, and might reasonably be used instead of anticoagulation (class 2b) for patients at moderate or high stroke risk who also face a high chance of serious bleeding while taking anticoagulants. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Recipient not specified; Population: Patients with atrial fibrillation. The ACC summary gives no age limits and, apart from the exceptions each claim names, no exclusions.; Care setting: Not stated in the ACC summary.; Geography: Not stated in the ACC summary (issued by American societies; jurisdiction not verified); Life stage: Not stated in the ACC summary; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (guideline context) - Limitations: The source is the ACC key-perspectives summary of the guideline (ACC content, hash only), not the guideline text. The classes of recommendation are as printed on the ACC page. These are weaker recommendations than a plain recommendation, so no recommendation record is written for them. PubMed lists three corrections to the guideline (2024-01-02, 2024-02-27 and 2024-06-11); their text was not read, so it is not known whether they change anything stated here. - Last checked: 2026-10-15 - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.) Locator: Key perspective 7, sentence 2. Retrieved 2026-10-15T13:52:56Z. Source state: Corrected. Snapshot hash: 351ef6a153a9922b720e0ea62e3c8ccb64abd9945012b3992bb58528d3446453. How it applies: Class 2a for a contraindication to long-term anticoagulation. 2. Supports: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.) Locator: Key perspective 7, sentence 3, fragments 1 and 2. Retrieved 2026-10-15T13:52:56Z. Source state: Corrected. Snapshot hash: 351ef6a153a9922b720e0ea62e3c8ccb64abd9945012b3992bb58528d3446453. How it applies: Class 2b for a high bleeding risk on anticoagulation. 3. Background: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines (Guideline, edition Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.) Locator: CommentsCorrectionsList, three ErratumIn entries. Retrieved 2026-10-15T13:48:58Z. Source state: Corrected. Snapshot hash: 3ee3998a9178e8f21223e2388261924207d5e1f8fb19bf34e8355e11eb2c07a9. How it applies: Shows that corrections exist. What they change is unknown. ## Connected pages - A device alternative to long-term blood thinners for some people: Blood thinners (oral anticoagulants) to prevent stroke in AF (`cardio:oral-anticoagulation`) - Filed under this front: Procedures and surgery (`cardio:front-procedures-and-surgery`) - Used by: WATCHMAN left atrial appendage closure device (`cardio:watchman`) - Investigated in: PROTECT AF (`cardio:protect-af`) ## Provenance Content hash: d711d8cc22ca8037a1684fe0aaa48e0c2914bfb29d2a2c1c15c86069080bb701 Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-14