Percutaneous left atrial appendage closure: evolution of devices and expanding clinical applications

INTRODUCTION: Percutaneous left atrial appendage closure (LAAC) is an increasingly relevant strategy for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are ineligible for long-term oral anticoagulation. Its clinical relevance continues to expand as device technology and operator experience evolve. AREAS COVERED: This review provides an updated synthesis of currently available LAAC devices - including contemporary and emerging technologies - and summarizes comparative evidence from major trials and registries. A structured literature search was performed in PubMed, Scopus, and Web of Science. Additional focus is dedicated to expanding clinical applications, including use in chronic kidney disease, persistent left atrial appendage thrombus, stroke despite anticoagulation, and combined procedures such as LAAC with atrial fibrillation ablation. EXPERT OPINION: LAAC is entering a new phase in which its role may broaden beyond traditional indications, driven by improved safety, individualized antithrombotic strategies, and promising innovations such as dual‑seal and exclusion‑based devices. Future research will determine whether LAAC can transition from a selective therapy into a mainstream option for stroke prevention.