[Patient selection for the implantation of a left atrial appendage occluder in primary and secondary prevention of cardioembolic stroke in atrial fibrillation].

The implantation of a left atrial appendage (LAA) occluder has evolved into an established non-pharmacological alternative to oral anticoagulation (OAC) in the prevention of cardioembolic stroke in patients with atrial fibrillation. While 2 randomized trials investigated the LAA occluder as an alternative treatment in patients who can also undergo OAC, current guidelines recommend the LAA occluder rather as a second line therapy if permanent OAC is not possible due to contraindications. This is in line with current practice where an LAA occluder is usually only implanted if OAC is contraindicated or stopped due to bleeding.

[Implantation of Watchman™ occluder of the left atrial appendage. Tips and tricks].

The implantation of an occluder system for the left atrial appendage (LAA) represents an interesting alternative for patients with atrial fibrillation and a CHA2DS2-VASc-Score ≥ 2 who cannot take permanent anticoagulation for various reasons. As in other left cardiac interventions, there are potentially dangerous possibilities for complications that can limit the advantages of this therapy. This overview summarizes practical tips and tricks at the implantation of a Watchman™ occluder which may help to minimize the complication rate.