Atrial fibrillation (AF) is the most common arrhythmia which increases the risk of ischemic stroke [ ]. In the United States alone it affects >2.6 million people [ ]. AF is also the most common arrhythmia after cardiac surgery [ ]. Patients with AF and high risk for stroke based on the CHA 2 DS 2 -Vasc score (congestive heart failure, hypertension, age, diabetes, stroke/transient ischemic attack, or vascular disease) are advised anticoagulation. However, some patients with AF are intolerant or decline anticoagulation, while others stop warfarin, dabigatran, xarelto, or apixaban after a few years due to noncompliance [ ]. Percutaneous left atrial appendage occlusion (LAAO) is an alternative to mitigate stroke in patients with non-valvular atrial fibrillation who are high risk for bleeding, intolerant to anticoagulation, or decline anticoagulation.