Stroke remains a major complication of atrial fibrillation and third leading cause of death in Western Countries. [1] While Coumadin and novel oral anticoagulants have been efficient in reducing the stoke risk in patients with atrial fibrillation; there is a subset of patients who are not candidates for anticoagulation. [2] The management of these patients is clinical challenge. We describe a patient with history of permanent atrial fibrillation with contra-indication to anticoagulation presenting with and left atrial thrombus. She was treated with novel generation of epicardial left atrial appendage exclusion device.