New LAAO Guidelines: 6 Key Takeaways for Interventional Cardiologists and Electrophysiologists
New LAAO Guidelines: 6 Key Takeaways for Interventional Cardiologists and Electrophysiologists
Date Published: August 4, 2025
Original Source: Journal of the Society for Cardiovascular Angiography and Interventions (JSCAI)
Background:
The Society for Cardiovascular Angiography and Interventions (SCAI) and the Heart Rhythm Society (HRS) have released new evidence-based guidelines for Left Atrial Appendage Occlusion (LAAO) to bring consistency and clarity to patient care.
These build upon a previous 2023 expert consensus but respond to the variation in real-world practice. The guidelines are not strict standards of care but provide strong recommendations to be adapted based on each patient’s situation and preferences.
6 Key Takeaways:
1. LAAO is recommended over no therapy
For patients with nonvalvular atrial fibrillation (NVAF) who cannot take oral anticoagulants (OAC), LAAO is preferred over doing nothing.
Patients and doctors should discuss stroke risk vs procedural risk to make an informed decision.
2. LAAO may still be considered even if OAC is possible
If the patient has high bleeding risk, past bleeding issues, or strongly prefers to avoid long-term medication, LAAO may be better than OAC.
3. Imaging is essential before and during the procedure
• Before: Use TEE (transesophageal echo) or cardiac CT.
• During: Use intracardiac echo (ICE) or TEE.
4. After LAAO, medication is still required
• Use either OAC or dual antiplatelet therapy (DAPT).
• If OAC is too risky (e.g., due to major bleeding history), DAPT is a reasonable alternative.
5. Follow-up imaging is needed
After the procedure, use TEE or cardiac CT to check if the LAAO device is working properly.
6. If a blood clot forms on the device, use OAC
• Device-related thrombus (DRT) should be managed with anticoagulation.
• However, the best duration and timing of OAC still needs more research.
Additional Notes:
• LAAO is an elective (non-emergency) procedure, so low complication rates and high quality are essential.
• The NCDR LAAO Registry is highlighted as a useful tool to improve outcomes and monitor performance across institutions.
