Left Atrial Appendage: Mere Spectator or Protagonist? A Narrative Review of Its Multimodal Imaging Assessment and Its Closure Techniques

Abstract

Background: For years, the left atrial appendage (LAA) was considered a simple recess of the atrial wall, but recently it has gained its own respectability in the cardiovascular field, therefore its accurate assessment cannot be overlooked in clinical practice. Percutaneous or surgical closure of the LAA has become a valid and safe alternative to reduce the risk of stroke in patients with non-valvular atrial fibrillation (AF), who have long-term contraindications to anticoagulant therapy. Results: This progression was feasible thanks to the developments and the improvements of devices, surgical and imaging techniques. Objectives: This review explores the essential role of multimodality imaging in LAA, including new imaging tools, and its impact on the optimization of closure techniques and outcomes. Conclusions: Multimodality imaging is mandatory for each step along the therapeutic path: patient selection, pre-procedural planning, procedural monitoring, and follow-up.