Key Institutional Requirements
Institutional volume
An aggregate of 50 structural heart disease or left-sided catheter ablations, at
least 25 of which involve transseptal puncture through an intact septum, should
be performed at the institution in the year leading to starting an LAA occlusion
program and per year thereafter (see Table 1 for qualifying left-sided procedures).
Note: The rationale is that not only the primary procedural specialist or
physician team, but also ancillary staff, should be comfortable with the basic
aspects of the procedure.
Procedural area
e procedure should be performed in the cardiac catheterization laboratory,
electrophysiolog y suite, or hybrid suite with continuous hemodynamic
monitoring.
Fixed radiographic imaging systems with fluoroscopy, offering catheterization
laboratory-quality imaging are required. e capability to acquire/record cine
loops is strongly recommended.
Mobile C-Arm for fluoroscopic imaging is NOT acceptable.
Biplane imaging is helpful but not required.
e room should be adequately sized to accommodate echocardiographic and
anesthesia equipment, in addition to the regular radiographic imaging system.
HAS-BLED Bleeding Risk Score
Hypertension
(systolic blood pressure >160)
1
Score Bleeds/100 patients
Abnormal renal and liver function
(1 point each)
1 or 2 0 1.13
Stroke (previous stroke)
1 1 1.02
Bleeding
1 2 1.88
Labile INRs
(<60% of time in therapeutic range)
1 3 3.74
Elderly (age > 65)
1 4 8.7
Drugs or alcohol (1 point each)
(drugs predisposing to bleeding
[antiplatelets, NSAIDs], alcohol
use [>8 drinks/week])
1 or 2 ≥5 ≥12.5
Maximum Score: 9
