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Left Atrial Appendage Occlusion

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Key Points Î Ischemic stroke remains a significant risk for patients with AF. Î Oral anticoagulants, while highly effective in reducing the risk of stroke, are associated with an increased risk of bleeding. Î Several non-pharmacologic approaches to LAA occlusion have evolved simultaneously, including endovascular occlusion, surgical suturing, stapling, and amputation. These methods have been shown to vary in their efficacy and safety. Î Percutaneous LAA occlusion has the potential to a have major, positive clinical impact on our treatment of certain subsets of patients with AF that are at risk for stroke. Î As this technology becomes clinically available to a broader population of patients, it is essential that physician stakeholders establish criteria for the performance of these procedures that will be used in granting initial and ongoing privileges. Î The FDA approval of the WATCHMAN device for percutaneous closure of the LAA represents an important addition to the physician's armamentarium to help mitigate this problem. CHADS 2 Score Centers for Medicare & Medicaid Services National Coverage Determination for Percutaneous Left Atrial Appendage Occlusion Therapy requires a CHADS 2 score ≥2. a Congestive HF 1 CHADS 2 Score Stroke Risk % Hypertension (>140/90 or on medication) 1 0 1.9 1 2.8 Age ≥75 y 1 2 4.0 Diabetes mellitus 1 3 5.9 Stroke/TIA/thromboembolic events 2 4 8.5 5 12.5 Maximum Score: 6 6 18.2 a https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo. aspx?NCAId=281

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