SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure

Jacqueline Saw; David R Holmes; João L Cavalcante; James V Freeman; Andrew M Goldsweig; Clifford J Kavinsky; Issam D Moussa; Thomas M Munger; Matthew J Price; Mark Reisman; Matthew William Sherwood; Zoltan G Turi; Dee Dee Wang; Brian K Whisenant

doi:10.1016/j.jscai.2022.100577

SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure

J Soc Cardiovasc Angiogr Interv. 2023 Mar 27;2(3):100577. doi: 10.1016/j.jscai.2022.100577. eCollection 2023 May-Jun.

Authors

Affiliations

¹ Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada.
² Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota.
³ Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota.
⁴ Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
⁵ Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska.
⁶ Division of Cardiovascular Medicine, Rush University, Chicago, Illinois.
⁷ Carle Heart and Vascular Institute, Carle Illinois College of Medicine, Urbana, Illinois.
⁸ Division of Cardiovascular Diseases, Scripps Green Hospital, La Jolla, California.
⁹ Division of Cardiology, Weill Cornell Medical Center, New York, New York.
¹⁰ Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, Virginia.
¹¹ Center for Structural and Congenital Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey.
¹² Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan.
¹³ Division of Cardiology, Intermountain Medical Center, Murray, Utah.

Abstract

Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices.

Keywords: CHA2DS2-VASc; device-related thrombus; embolic stroke prevention; left atrial appendage closure; non-valvular atrial fibrillation; peridevice leak.