SCAI/HRS Technical Review on Transcatheter Left Atrial Appendage Occlusion.

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Nonvalvular atrial fibrillation (NVAF) increases stroke risk via left atrial appendage thrombi.
• Oral anticoagulation (OAC) is standard but carries bleeding risks.
• Percutaneous left atrial appendage occlusion (LAAO) is an alternative, but practice varies.

Purpose of the Study:

• Synthesize evidence on LAAO for stroke prevention in NVAF.
• Inform new Society for Cardiovascular Angiography & Interventions (SCAI) and Heart Rhythm Society (HRS) guidelines.
• Address variability in LAAO patient selection, imaging, and management.

Main Methods:

• Systematic review of PubMed, Embase, and Cochrane Library (inception-Jan 2024).
• Included adult NVAF patients undergoing LAAO, with peridevice leak or device-related thrombus.
• Excluded surgical LAAO, double devices, combined procedures, and non-US marketed devices.

Main Results:

• 27 studies met eligibility criteria from 3769 titles/abstracts.
• Analyzed LAAO outcomes for stroke prevention vs. OAC and no therapy.
• Examined preprocedure imaging, intraprocedure guidance, and postprocedure antithrombotic regimens.

Conclusions:

• Left atrial appendage occlusion (LAAO) is effective for stroke prevention in NVAF patients with bleeding risks.
• Uncertainties persist regarding optimal imaging strategies.
• Further clarification is needed for postprocedural management protocols.