The review will assess the effectiveness of left atrial appendage closure (LAAC) for the prevention of stroke in patients with atrial fibrillation (AFib) compared to oral anticoagulation. The review question was chosen because AFib is a common and serious condition, it is the most common arrhythmia seen in clinical practice and is associated with a five-fold increase in the risk of stroke. Strokes related to AFib are more severe, with twice the death rate of non-AFib related strokes and greater functional deficits for those who survive. It accounts for 15–20% of strokes in the general population and up to 30% in patients over 80 years of age. The volume of the left atrial appendage increases in patients with AFib and this appendage is the most common place for thrombus formation with release leading to embolic stroke in patients with non-valvular AFib. As the souce of embolism it was originally hypothesised that resection of the appendage might reduce the risk of stroke. Less invasive surgical procedures have been developed to close the appendage using a mechanical device. Data indicates that this procedure is feasible and safe and may be an alternative to oral anticoagulants. The study selection criteria will be randomised controlled trials assessing the effectiveness of left atrial appendage closure in patients with AFib. The primary outcome for this review will be stroke with secondary outcomes of bleeding, mortality, quality of life and cost also being assessed.
