Graphical Abstract.

Rationale for left atrial appendage closure. Because of changing demographics, the number of atrial fibrillation patients is expected to double in industrialized countries within the next two decades. Patients with high risk for stroke have an indication for stroke preventive therapies consisting of either oral anticoagulation, percutaneous left atrial appendage closure in case of high bleeding risk, or surgical left atrial appendage closure in patients undergoing cardiac surgery. Several ongoing studies will more precisely define the optimal therapeutic approach for the individual patient. AF, atrial fibrillation, CABG, coronary artery bypass grafting; OAC, oral anticoagulation; LAAC, left atrial appendage closure.