2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion

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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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