Thrombus within the left atrial appendage can be a source of cerebral emboli in patients with atrial fibrillation. Closure of the left atrial appendage may be appropriate if certain conditions are present.

Patient selection: atrial fibrillation


Indications for closure of the left atrial appendage (LAA):

(1) The atrial fibrillation is non-valvular.

(2) The patient is at risk for thromboemboli (CHA2DS2-VASc score >= 2).

(3) The patient has one or both of the following:

(3a) The patient is at increased risk for bleeding or complications while taking oral anticoagulation.

(3b) There is no effective anticoagulation therapy available for the patient.


Increased risk for bleeding or complications may involve:

(1) A HAS-BLED score >= 3.

(2) A history of recurrent bleeding while taking oral anticoagulants.

(3) The patient has contraindications to anticoagulant therapy.

(4) The patient is intolerant of anticoagulant therapy.


Lack of effective anticoagulant therapy may involve:

(1) The patient has a history of stroke or TIA while taking oral anticoagulant.

(2) The patient shows persistent non-adherence to anticoagulation therapy.

(3) The patient is unwilling to taking oral anticoagulants.


CMS requires that:

(1) There has been a shared decision-making interaction between the patient and a non-interventional physician, and that this is fully documented in the medical record.

(2) The physician performing the procedure be qualified by training and experience.

(3) The patient is enrolled in a national registry that tracks outcomes.

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