At Cardiology Update 2025 in London, I presented an evidence-focused overview of left atrial appendage (LAA) closure for stroke prevention in atrial fibrillation. The lecture summarized established clinical evidence and discussed the newest randomized data, including the OPTION Trial and the preliminary results of CLOSURE AF.
Atrial fibrillation remains a major cause of embolic stroke. While oral anticoagulation is effective, real-world challenges such as adherence and bleeding risk limit its long-term performance. LAA closure offers a one-time, local therapy that provides durable protection independent of compliance.
More than two decades of studies, including PROTECT AF, PREVAIL, PRAGUE-17 and several propensity-matched analyses, consistently demonstrate comparable stroke prevention, reduced long-term bleeding and high procedural success rates with current-generation devices.
The OPTION Trial showed non-inferior efficacy compared with continued oral anticoagulation after AF ablation and demonstrated a significant reduction in non-procedural major bleeding. In contrast, the preliminary results of CLOSURE AF involved a fundamentally different, extremely high-risk population characterized by advanced age, higher CHA₂DS₂-VASc and HAS-BLED scores, CKD and frailty.
LAA closure remains a valuable treatment strategy when applied to the appropriate patient groups. Ongoing studies such as CHAMPION AF and LAAOS IV will further refine patient selection.