This guidance replaces previous guidance on percutaneous occlusion of the left atrial appendage for atrial fibrillation (interventional procedure guidance 181).
1.1 Current evidence suggests that percutaneous occlusion of the left atrial appendage (LAA) is efficacious in reducing the risk of thromboembolic complications associated with non-valvular atrial fibrillation (AF). With regard to safety, there is a risk of life-threatening complications from the procedure, but the incidence of these is low. Therefore, this procedure may be used provided that normal arrangements are in place for clinical governance, consent and audit.
1.2 Patient selection should be carried out by a multidisciplinary team including a cardiologist and other appropriate clinicians experienced in the management of patients with AF at risk of stroke. Patients should be considered for alternative treatments to reduce the risk of thromboembolism associated with AF, and should be informed about these alternatives.
1.3 Percutaneous occlusion of the LAA is a technically challenging procedure which should only be carried out by clinicians with specific training and appropriate experience in the procedure.
1.4 This procedure should be carried out only in units with on-site cardiac surgery.
1.5 Any device-related adverse events resulting from the procedure should be reported to the Medicines and Healthcare products Regulatory Agency (MHRA).