SCAI/ACC/HRS Institutional and Operator Requirements for Left Atrial Appendage Occlusion

• Published in: Journal of the American College of Cardiology Vol. 67; no. 19; pp. 2295 - 2305
• Main Authors: Kavinsky, Clifford J., MD, PhD, FACC, FSCAI, Kusumoto, Fred M., MD, FACC, FHRS, Bavry, Anthony A., MD, MPH, FACC, Bailey, Steven R., MD, FACC, MSCAI, Ellenbogen, Kenneth A., MD, FACC, FHRS, Hess, Paul L., MD, MHS, Lustgarten, Daniel L., MD, PhD, FACC, FHRS, Moussa, Issam D., MD, FACC, FSCAI, Spies, Christian, MD, FACC, FSCAI
• Format: Journal Article Conference Proceeding
• Language: English
• Published: United States Elsevier Inc 17.05.2016; Elsevier Limited
• Subjects: Anticoagulants; Atrial Appendage - surgery; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Cardiology; Cardiovascular; Catheters; FDA approval; Heart surgery; Humans; Internal Medicine; Occlusion; Stroke; Stroke - etiology; Stroke - prevention & control; structural heart disease; Therapeutic Occlusion - instrumentation; Therapeutic Occlusion - standards; stroke; atrial fibrillation; structural heart disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.12.001

[...]there is agreement that non-pharmacologic treatment for stroke prevention has been an unmet need, which has stimulated the development of alternatives to pharmacologic therapies. [...]it is essential that stakeholders have a thorough understanding of the cognitive and technical aspects surrounding LAA occlusion in general and the various technologies for LAA occlusion currently available and in development.Cognitive Requirements Percutaneous LAA occlusion is a new technique, and a significant learning curve for deployment of the WATCHMAN device has demonstrated reduced procedure time, decreased complications, and improved procedural success rates with increasing operator experience (9,10). Centers without an on-site cardiothoracic surgery service available and ready for emergent operation should not have an LAA occlusion implant program. Besides tamponade, the management team must monitor the patient for other complications, including procedure-related stroke, air embolus, and device embolization, all of which are mitigated by sophisticated handling of the sheath delivery system and the anticoagulation status of the patient during the procedure. [...]proctors who are experienced in LAA occlusion with a specific device should be present to monitor the initial implants performed by the procedural specialist.