2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion

August 4, 2025 — The Society for Cardiovascular Angiography & Interventions (SCAI) and the Heart Rhythm Society (HRS) developed the 2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion (LAAO) to provide evidence-based recommendations for stroke prevention in patients with nonvalvular atrial fibrillation (AF).

These guidelines address ongoing variation in clinical practice and offer practical guidance on patient selection, procedural imaging, antithrombotic therapy, and management of post-procedural complications. Developed using a rigorous systematic review and GRADE methodology, the document includes eight key recommendations and highlights important knowledge gaps to guide future research.

LAAO is presented as an important alternative to long-term oral anticoagulation (OAC), particularly for patients with contraindications to anticoagulation or elevated bleeding risk. The document emphasizes shared decision-making, recognizing that treatment choices should reflect individual patient values, risks, and preferences.

Key areas addressed in the guideline include:

• Patient selection for LAAO versus oral anticoagulation or no therapy
• Pre- and intraprocedural imaging (e.g., TEE, CT, intracardiac echocardiography)
• Post-procedural antithrombotic strategies, including OAC and dual antiplatelet therapy
• Follow-up imaging to detect complications such as peridevice leak (PDL) and device-related thrombus (DRT)
• Management of complications, including uncertainty around optimal treatment for PDL and duration of therapy for DRT

The guidelines also underscore the evolving nature of LAAO, including advances in device technology, procedural techniques, and ongoing clinical trials that may expand its role in atrial fibrillation management.