**Abstract**

Patients with non-valvular atrial fibrillation (NVAF) are at an increased risk of ischemic stroke due to the risks of thrombus formation. The left atrial appendage (LAA) is shown to be "the culprit" of thromboembolic events in NVAF and is currently a therapeutic target to prevent stroke. The absolute benefit of oral anticoagulation in the management of NVAF to improve cardiovascular outcomes has been well established. However, some patients are not good long-term candidates for oral anticoagulation for many reasons, including risks of bleeding, noncompliant to oral anticoagulation (OAC). Left atrial appendage occlusion (LAAO) provides an attractive alternative to reduce the risk of stroke for those who are contraindicated to OAC therapy.

**Keywords:** atrial fibrillation, left atrial appendage closure, left atrial appendage device, ischemic stroke, oral anticoagulation

## **1. Introduction**

In patients with non-valvular atrial fibrillation (NVAF), oral anticoagulation (OAC) is part of mainstream therapy to prevent ischemic stroke [1], and the left atrial appendage (LAA) remains a focus of thrombus formation [2]. However, there are several situations that oral anticoagulation may be unsuitable, due to any individual history of major bleeding, personal risks of bleeding (e.g., fall risk in elderly or cerebral anomalies), noncompliant patients to OAC, or patients with high-risk occupation. Left atrial appendage occlusion (LAAO) has emerged as an alternative management to prevent stroke in NVAF patients who are not eligible for continuous OAC [3].
