Since atrial fibrillation affects 1–2% of the global population and is expected to rise significantly by 2050, the urgency to address its associated risks, particularly embolic stroke, is paramount. Traditionally, anticoagulation with vitamin K antagonist, while effective, has shown several limitations, including the close monitoring necessary, bleeding risks, and compliance issues. Novel oral anticoagulants (NOACs) offer promising alternatives, yet their higher cost and potential for interruptions due to side effects remain concerns. As a result, percutaneous left atrial appendage closure (LAAC) has emerged as a nonpharmacological alternative for selected patients, especially those who have contraindications or are intolerant to oral anticoagulants. LAAO, through devices like WATCHMAN and Amplatzer Amulet, aims to prevent stroke by mechanically blocking the site most prone to thrombus formation in the heart. The integration of cost-effectiveness analyses and real-world data underscores the importance of personalized approaches in stroke prevention strategies for AF patients, promising improved outcomes and reduced disease burden. Here, we review patient selection criteria and preoperative evaluations using multimodality imaging. We also discuss the general evolving landscape of LAAC compared to oral anticoagulant therapies.