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Updated: Sep 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
2025 SCAI/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion
Andrew M Goldsweig1, Michael Glikson2, Jacqueline Joza3
1Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, Massachusetts.
Insights
Left atrial appendage occlusion (LAAO) devices reduce stroke risk in atrial fibrillation patients. These guidelines address LAAO best practices, including patient selection and managing complications like peridevice leak.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Left atrial appendage occlusion (LAAO) devices offer stroke risk reduction for atrial fibrillation patients compared to no anticoagulation.
- Persistent uncertainties exist regarding optimal patient selection, imaging, antithrombotic therapy, and management of peridevice leak (PDL) and device-related thrombus (DRT).
Purpose of the Study:
- To provide evidence-based guidelines for Left Atrial Appendage Occlusion (LAAO) procedures.
- To address practice variations and support clinical decision-making in LAAO management.
Main Methods:
- A multidisciplinary guideline panel convened, utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
- Systematic reviews of published evidence were conducted by expert technical review teams.
- Recommendations were formulated using the GRADE evidence-to-decision framework.
Main Results:
- Eight evidence-based recommendations were developed to standardize care for LAAO procedures.
- Two significant knowledge gaps were identified regarding LAAO management.
Conclusions:
- Key recommendations focus on patient selection, periprocedural imaging, antithrombotic strategies, and managing PDL and DRT.
- Future research is recommended on single antiplatelet therapy post-LAAO and PDL management.
Background:
Left atrial appendage occlusion (LAAO) devices reduce the risk of atrial fibrillation-associated stroke relative to no oral anticoagulation. However, uncertainty and practice variation persist in the areas of patient selection, periprocedural imaging, adjunctive antithrombotic therapy, and management of peridevice leak (PDL) and device-related thrombus. The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society developed these evidence-based guidelines to support clinicians, patients, and other stakeholders in management decisions regarding LAAO.
Methods:
The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society convened a balanced, multidisciplinary guideline panel with <50% of members reporting significant conflicts of interest with the industry. Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for guideline development. The guideline panel formulated and prioritized clinical questions following the Grading of Recommendations Assessment, Development, and Evaluation approach in a population, intervention, comparison, outcome format. A technical review team of clinical and methodological experts conducted systematic reviews of the published evidence, synthesized data, and graded the certainty of evidence across outcomes. The guideline panel then developed recommendations and supporting statements informed by the technical review and using the Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework.
Results:
The guideline panel developed 8 evidence-based recommendations to address variations in care related to LAAO. The panel also identified 2 knowledge gaps.
Conclusions:
Key recommendations address patient selection for LAAO, periprocedural imaging, adjunctive antithrombotic therapy, and management of PDL and device-related thrombus. The panel also recommended necessary future research regarding the use of single antiplatelet therapy following LAAO and regarding the management of PDL.
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