Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Interventions, S1936879823000122. https://doi.org/10.1016/j.jcin.2023.01.011 Dr. Jacqueline Saw et al.
Points
- The Society for Cardiovascular Angiography & Interventions/Heart Rhythm Society (SCAI/HRS) provides guidance on transcatheter left atrial appendage closure (LAAC) in patients with nonvalvular atrial fibrillation (AF) who cannot undergo long-term oral anticoagulation (OAC).
- LAAC is suitable for patients with nonvalvular AF with high thromboembolic risk who have a life expectancy of at least one year and sufficient quality of life to benefit from the procedure.
- Physicians performing LAAC should have prior experience in left-sided ablations, structural procedures, and transseptal punctures (TSPs) and undergo regular maintenance of skills.
- The procedure involves baseline and intraprocedural imaging, predischarge imaging, and antithrombotic therapy tailored to the bleeding risks of each patient.
- Routine closure of iatrogenic atrial septal defects associated with LAAC should not be performed. Combined procedures with LAAC are not routinely recommended as data are pending from ongoing randomized controlled trials.
Summary
The Society for Cardiovascular Angiography & Interventions/Heart Rhythm Society (SCAI/HRS) Expert Consensus Statement on transcatheter left atrial appendage closure (LAAC) aims to guide the use of LAAC in patients with nonvalvular atrial fibrillation (AF) who are not suitable for long-term oral anticoagulation (OAC). AF is associated with a significantly increased risk of ischemic stroke and accounts for a substantial proportion of cerebrovascular accidents in the United States. Historically, the standard of care for stroke prevention in AF has been OAC, but this treatment has limitations that have led to a need for nonpharmacologic therapies such as LAAC.
The consensus statement recommends that LAAC is appropriate for patients with nonvalvular AF who have a high thromboembolic risk and are not suitable for long-term OAC but who have a life expectancy of at least one year and sufficient quality of life to benefit from the procedure. It is also recommended that physicians performing LAAC have prior experience in left-sided ablations, structural procedures, and transseptal punctures (TSPs) and that they undergo regular maintenance of skills. In addition, baseline and intraprocedural imaging is recommended, as well as predischarge imaging, to rule out pericardial effusion and device embolization.
The statement also provides guidance on technical aspects of the procedure, including venous access, anticoagulation, transseptal puncture, and device deployment. It also recommends that patients are prescribed antithrombotic therapy after LAAC according to the studied regimen and instructions for use for each specific device and tailored to the bleeding risks of each patient. Routine closure of iatrogenic atrial septal defects associated with LAAC should not be performed. Combined procedures with LAAC are not routinely recommended as data are pending from ongoing randomized controlled trials. Overall, the consensus statement provides a comprehensive guide to using LAAC in patients with nonvalvular AF who are unsuitable for long-term OAC.
Link to the article: https://www.jacc.org/doi/10.1016/j.jcin.2023.01.011
References Saw, J., Holmes, D. R., Cavalcante, J. L., Freeman, J. V., Goldsweig, A. M., Kavinsky, C. J., Moussa, I. D., Munger, T. M., Price, M. J., Reisman, M., Sherwood, M. W., Turi, Z. G., Wang, D. D., & Whisenant, B. K. (2023). Scai/hrs expert consensus statement on transcatheter left atrial appendage closure. JACC: Cardiovascular Interventions, S1936879823000122. https://doi.org/10.1016/j.jcin.2023.01.011
