Guidelines Address Transcatheter LAAO for Stroke Prevention in Patients With NVAF

August 6, 2025—The Society for Cardiovascular Angiography & Interventions (SCAI) and the Heart Rhythm Society (HRS) announced the publication of rigorous, evidence-based, multisociety recommendations to guide the use of transcatheter left atrial appendage occlusion (LAAO) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF).

The guidelines, which provide specific recommendations for clinicians, patients, and policymakers, are intended to support shared decision-making between clinicians and patients, promote quality improvement initiatives, and inform policy and coverage decisions, advised the societies.

The 2025 SCAI/HRS clinical practice guidelines on transcatheter LAAO were published by Andrew M. Goldsweig, MD, et al, in JSCAI and Heart Rhythm Journal. Dr. Goldsweig and Christopher R. Ellis, MD, are co-chairs of the guideline writing group.

An accompanying technical review by Edmond M. Cronin, MB BC, et al provides a detailed analysis of the underlying evidence base, highlighting both the progress and ongoing knowledge gaps in the field.

As noted in the press release, the SCAI and HRS multidisciplinary panel that was convened to develop these comprehensive guidelines was composed of interventional cardiologists, electrophysiologists, cardiovascular imaging specialists, and methodological experts. A systematic review of more than 3,700 studies was conducted to evaluate evidence on eight key clinical questions.

The guidance addresses patient selection; preprocedural imaging; intraprocedural imaging; postprocedural antithrombotic therapy; surveillance imaging; and management of complications.

Additionally, critical research priorities identified in the guidelines include: optimal antithrombotic regimens after LAAO, particularly the role of single antiplatelet therapy; best practices for managing peridevice leak and device-related thrombus; the utility of routine postprocedural imaging, including optimal timing and modality; and the role of LAAO in broader NVAF populations beyond those with oral anticoagulation contraindications, stated the SCAI and HRS in the press release.