Societies Issue Recommendations for LAA Occlusion

June 29, 2015—A new overview on the implantation of left atrial appendage (LAA) occlusion devices was released by the American College of Cardiology (ACC), Heart Rhythm Society (HRS), and Society for Cardiovascular Angiography and Interventions (SCAI). It is published online on the websites of the ACC (www.acc.org), HRS (www.hrsonline.org), and SCAI (www.scai.org) and will appear in future issues of the Journal of the American College of Cardiology, HRS’s Heart Rhythm, and SCAI’s Catheterization and Cardiovascular Interventions.

This document is the first in a series from the ACC, HRS, and SCAI that will address the integration of new technologies into the care of patients with atrial fibrillation.

The societies noted that the implantation of LAA occlusion devices may lower the risk of stroke in patients with atrial fibrillation, and as new devices are developed, it is anticipated that the use of LAA occlusion technologies in clinical practice will expand.

The recommendations urge that new technology should be disseminated thoughtfully, with emphasis on team-based care and the collection of the necessary data in longitudinal registries to determine ideal patient selection, effectiveness, and safety. It will also be necessary to develop and implement new guidelines, expert consensus statements, requirements for training, operator credentialing, and institutional policies.

In the societies’ announcement, Frederick A. Masoudi, MD, who is Chair of the writing committee, commented, “This document highlights the critical issues surrounding LAA occlusion therapies. We aimed to facilitate the alignment among patients and their families, primary care physicians, general cardiologists, and additional heart team members and procedural specialists. We also identified the need to collect robust clinical data on outcomes for patients who are treated with these devices in clinical practice, especially because in some cases, the evidence for some devices in use is sparse.” Dr. Masoudi is Professor of Medicine at the University of Colorado Anschutz Medical Campus in Aurora, Colorado.

The societies advise that LAA occlusion may be considered in cases where oral anticoagulants, which are the standard of care to reduce risk of stroke in patients with atrial fibrillation, are contraindicated or the patient is unable or unwilling to adhere to long-term oral anticoagulation therapy.

The societies also stated that the use of LAA occlusion devices is likely to increase with the recent US Food and Drug Administration approval of the Watchman device (Boston Scientific Corporation), which is indicated for patients who are at an increased risk of stroke based upon their clinical profile, are deemed suitable for anticoagulation therapy with warfarin, and have an appropriate rationale to seek a nonpharmacologic alternative to warfarin therapy after taking into account the safety and effectiveness of the device.