Left atrial appendage exclusion for atrial fibrillation: does the protection from stroke prevail in the long-term?

On March 13^th 2015, the approval of the Watchman left atrial appendage (LAA) closure device (Boston Scientific, Marlborough, MA, USA) by the Food and Drug Administration (FDA) introduced an important tool for stroke prevention for patients with atrial fibrillation (AF) in the United States (1). AF is the most common arrhythmia in clinical practice and afflicts approximately 33.5 million people worldwide (2). Stroke is a feared complication of AF, and systemic anticoagulation is a standard of care for stroke prevention in AF. However, systemic anticoagulation is fraught with potential disadvantages, such as bleeding, need for compliance with medication, compliance with a regular diet in case of warfarin, medication interactions, and need for temporary interruption during surgical procedures.