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Atrial fibrillation (AF) is a prevalent disease that affects up to 3% of the population and accounts for 1--3% of health care costs due to stroke, sudden death, heart failure, unplanned hospitalizations and other complications. Once non-valvular AF is diagnosed, a multidisciplinary and multifaceted approach is required, including acute management, treatment of underlying and concomitant conditions, rate and rhythm control, and prevention of the most feared complication, stroke. The tendency for blood pooling in the left atrium and left atrial appendage (LAA) due to AF was first reported in 1996, and although oral anticoagulation with vitamin K antagonists and direct oral anticoagulants (DOACs) has significantly reduced stroke risk, up to 40% of patients with AF are untreated, due to intolerance, bleeding, or other contraindications.

My patient cannot or will not comply with oral anticoagulation. Do I cross my fingers or cross the septum?