Stroke remains the most feared complication in patients with atrial fibrillation. While oral anticoagulation is used in most patients, it can be ineffective and sometimes contraindicated. Patients with atrial fibrillation undergoing cardiac surgery should have their left atrial appendage excised or excluded. Traditional surgical treatment has involved excision or exclusion with sutures or staplers. Recently, less invasive epicardial atrial excision devices have been introduced, which can be applied without cardiopulmonary bypass and with minimally invasive access.