2025 SCAI/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion

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.