With a steadily increasing prevalence, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk factor for stroke caused by thromboembolic events. The left atrial appendage (LAA) is the primary source of thromboemboli in patients with nonvalvular AF who have a stroke. Novel strategies (such as mechanical and nonpharmacological intervention) targeting the LAA in patients with AF for stroke prevention have become a major focus during the past decade. Some devices for percutaneous LAA occlusion are supported by robust clinical data obtained from randomized trials or large registries, and are a valid alternative to pharmacological stroke prevention. However, the incidence of periprocedural complications and the presence of device-related thrombi or residual LAA leaks, whose long-term clinical implications are still unknown, are limiting factors in wider acceptability of these techniques. In this Review, we discuss the available techniques for LAA occlusion in patients with nonvalvular AF at high risk of stroke. We describe the pharmacological and mechanical approaches to LAA occlusion, and provide the current clinical evidence for various strategies. We particularly focus on the current management of the LAA, and discuss the challenges and future implications of the available approaches to LAA occlusion.

随着患病率的稳步提高，房颤（AF）是全世界最常见的持续性心律不齐，并且是由血栓栓塞事件引起的中风的独立危险因素。非卒中性非瓣膜性房颤患者的左心耳（LAA）是血栓栓塞的主要来源。在过去的十年中，针对房颤患者的LAA的新策略（例如机械和非药物干预）已成为主要关注点。一些用于经皮LAA闭塞的设备得到了来自随机试验或大型注册机构的可靠临床数据的支持，并且是预防中风药理学的有效替代方法。但是，围手术期并发症的发生率以及与设备相关的血栓或残留的LAA泄漏的存在，其长期临床意义仍然未知，是这些技术更广泛被接受的限制因素。在这篇综述中，我们讨论了在中风风险高的非瓣膜性房颤患者中用于LAA闭塞的可用技术。我们描述了LAA闭塞的药理和机械方法，并为各种策略提供了当前的临床证据。我们特别关注LAA的当前管理，并讨论可用的LAA阻塞方法的挑战和未来意义。并为各种策略提供当前的临床证据。我们特别关注LAA的当前管理，并讨论可用的LAA阻塞方法的挑战和未来意义。并为各种策略提供当前的临床证据。我们特别关注LAA的当前管理，并讨论可用的LAA阻塞方法的挑战和未来意义。