SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Arial Appendage Closure (Joint Session)-SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Arial Appendage Closure (Joint Session)

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Video Summary

The session was co-chaired by Dr. Chris Ellis and Julia Indyk, focusing on developing a clinical practice guideline for left atrial appendage closure (LAC). The guideline, created through collaboration between the Society for Cardiovascular Angiography and Interventions (SCAI) and the Heart Rhythm Society (HRS), aims to optimize patient care in interventional cardiology by recommending practices based on systematic evidence reviews and the GRADE approach, which assesses recommendations' strength and evidence certainty.<br /><br />Dr. Jackie Saw explained that the guideline panel involved committees from both organizations and utilized the GRADE approach to rate outcomes. This process, requiring unanimous panel agreement or formal voting, led to either strong or conditional recommendations with levels of certainty from high to very low. Dr. Ed Cronin detailed the technical review process, involving thorough literature reviews and evidence grading, highlighting the differentiation between the GRADE approach and other traditional methods, such as those used by AHA and ACC.<br /><br />The panel addressed clinical questions involving LAC, offering conditional recommendations in many areas due to limited high-certainty data, such as suggesting LAC over no anticoagulation in specific scenarios, or addressing post-procedural management with either oral anticoagulants or dual antiplatelet therapy.<br /><br />Case presentations explored guidelines' applications in real-world scenarios, including discussions on complex cases like device-related thrombus (DRT) management, considering the unresolved gaps in knowledge where no recommendation was made. They emphasized the importance of personalized patient management and the need for continued research on anticoagulation strategies, post-procedural imaging, and addressing peridevice leaks.

Keywords

clinical practice guideline

left atrial appendage closure

interventional cardiology

GRADE approach

Society for Cardiovascular Angiography and Interventions

Heart Rhythm Society

patient care optimization

evidence reviews

anticoagulation strategies

device-related thrombus