Atrial fibrillation is one of the most common arrhythmias and significantly increases the risk of stroke, and the left atrial appendage is the main source of thrombus. Therefore, the management of the left atrial appendage in the surgical treatment of atrial fibrillation can effectively prevent stroke. However, there are various strategies to manage the left atrial appendage, each with advantages and disadvantages, and their effects of stroke prevention are not the same. Therefore, we evaluated the three most common surgical strategies, including left atrial appendage resection, left atrial appendage ligation and left atrial appendage clamp. We discussed the effect of these strategies on stroke prevention based on multiple dimensions such as surgical difficulty, surgical cost and postoperative stroke incidence, thus trying to provide some guidance for the selection of left atrial appendage treatment in patients with atrial fibrillation.
Left atrial appendage closure (LAAC) serves as a non-pharmacological stroke prevention therapy for atrial fibrillation patients, suited for people with anticoagulation contraindications or high bleeding risks. Occluders Watchman, LAmbre and Amplatzer Cardiac Plug have received generational upgrades, with notably improved safety and clinical adaptability. For intraoperative image guidance, intracardiac echocardiography (ICE) surpasses transesophageal echocardiography (TEE) in image clarity, precision, tolerance and radiation management, and can partially replace TEE. Chinese clinical data validate the safety and effectiveness of ICE-guided LAAC, especially for seniors and patients with complex cardiac anatomy. Future technical optimization, systematic training and multi-technology integration will support more precise and extensive clinical promotion of LAAC.