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