Atrial fibrillation affects about 3% of all persons older than 65 years of age. About 30% of patients with chronic atrial fibrillation suffer from at least one cerebrovascular accident. On the other hand, atrial fibrillation is responsible for 15 - 20% of all cerebrovascular insults. A CHADS2 score of 3 points or more has been found to be a reliable predictor of future cerebrovascular events in patients with chronic atrial fibrillation. Oral anticoagulation remains the mainstay of treatment to prevent thromboembolic complications. Percutaneous closure of the left atrial appendage is a promising approach and probably a valid alternative in older patients intolerant to oral anticoagulation.