The Watchman Device has transformed left atrial appendage occlusion therapy, offering a minimally invasive solution for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. As clinical adoption expands and evidence from major trials continues to accumulate, cardiologists frequently explore the latest updates on the Watchman Device when attending structural-heart tracks at a cardiology conference. Increasingly, clinicians also examine the evolving field of LAAC procedural strategies, which now includes next-generation devices, refined imaging approaches and more precise peri-procedural anticoagulation pathways. This session provides a comprehensive and forward-looking review of current practice and emerging innovation.

The description begins by outlining the clinical rationale behind left atrial appendage occlusion, emphasising the role of the appendage in thrombus formation and the challenges associated with chronic anticoagulant use in high-risk patients. Participants review patient-selection criteria, risk stratification tools and contraindications, including bleeding history, fall risk, renal impairment, medication intolerance and lifestyle factors affecting anticoagulation safety.

Procedural aspects are explored in depth, with attention to imaging-guided planning using TEE, CT angiography and intracardiac echocardiography. Attendees examine appendage anatomy, landing zones, depth measurements, ostial sizing and device-compatibility considerations. Procedural steps—including transseptal puncture, sheath positioning, device deployment, verification tests and peri-device leak assessment—are discussed with case-based examples.

The session also highlights post-procedure management, focusing on anticoagulation transitions, antiplatelet pathways, follow-up imaging schedules and criteria for long-term therapy discontinuation. Participants learn to interpret surveillance imaging, identify residual leak, detect device-related thrombus and guide clinical decision-making.

Special sections address challenging anatomies, device-selection criteria, procedural complications, management of pericardial effusion, air embolism prevention and strategies for optimising long-term outcomes. Comparative discussions include next-generation occlusion devices, future Watchman iterations and the expanding role of LAAC in reducing global stroke burden.

Future directions explore real-world registries, AI-driven procedural planning, simplified outpatient workflows and expanding indications for high-risk AF populations. By the end of the session, clinicians gain a structured understanding of current LAAC best practices and pathways for integrating device therapy into comprehensive stroke-prevention strategies.