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

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2025-09-01 DOI:10.1016/j.jscai.2025.103783

Andrew M. Goldsweig MD, MS, FSCAI , Michael Glikson MD , Jacqueline Joza MD , Clifford J. Kavinsky MD, PhD, MSCAI , Omar Khalique MD, FSCAI , Dhanunjaya Lakkireddy MD , G. Burkhard Mackensen MD, PhD, FSCAI , Gerald V. Naccarelli MD , Devi G. Nair MD , Jacqueline Saw MD, FSCAI , Rahul Prakash Sharma MD, FSCAI , Matthew Sherwood MD, FSCAI , Molly Szerlip MD, FSCAI , Yngve Falck-Ytter MD , Rebecca L. Morgan PhD, MPH , Chelsea Armah MPH , Scott Firestone MS , Angela Fix MPH, MWC , Emily Senerth MS, MPH , Christopher R. Ellis MD

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Abstract

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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2025 SCAI/HRS经导管左心耳闭塞临床实践指南

背景：相对于无口服抗凝剂，左心耳闭塞（LAAO）装置可降低房颤相关卒中的风险。然而，在患者选择、围手术期成像、辅助抗血栓治疗、围器械泄漏（PDL）和器械相关血栓的处理等方面，不确定性和实践差异仍然存在。心血管血管造影与干预学会和心律学会制定了这些循证指南，以支持临床医生、患者和其他利益相关者对LAAO的管理决策。方法心血管血管造影介入和心律学会召集了一个平衡的多学科指南小组，其中50%的成员报告了与行业的重大利益冲突。证据基金会是一家注册的501(c)(3)非营利组织，为指南的制定提供了方法上的支持。指南小组按照人群、干预、比较、结果的分级建议评估、发展和评估方法，制定并优先考虑临床问题。由临床和方法学专家组成的技术审查小组对已发表的证据、综合数据进行了系统审查，并对证据的确定性进行了评分。然后，指南小组根据技术审查并使用从证据到决策的建议分级评估、发展和评价框架，制定了建议和支持性声明。结果指南小组提出了8项基于证据的建议，以解决LAAO相关护理的差异。该小组还发现了两个知识缺口。结论：主要建议包括LAAO患者的选择、围手术期成像、辅助抗栓治疗以及PDL和器械相关血栓的处理。该小组还建议对LAAO后单一抗血小板治疗的使用和PDL的管理进行必要的未来研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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