SCAI GUIDELINES Bundle (free trial)

Table 1. LAA Occlusion Program Components – Summary Procedural Specialist a Initial qualification 50 lifetime structural or le-sided catheter ablation procedures, at least 25 of which involved transseptal puncture through an intact septum b Clinical knowledge that includes a comprehensive understanding of stroke and bleeding risk in atrial fibrillation and appropriate treatment strategies Experience with catheter-based management of potential complications, including pericardiocentesis and embolized device retrieval Suitable training on the devices to be used Understanding of le atrial appendage anatomy and imaging Ongoing Over a 2-year period, 25 procedures that involve transseptal puncture through an intact septum, 12 of which are LAA occlusion procedures Process for identifying whether additional training is required on the basis of technological or clinical changes Institutional 50 structural or le-sided catheter ablations/year, at least 25 of which involved transseptal puncture through an intact septum in the year leading to program initiation and per year thereaer Continuous intraprocedure availability of a physician with experience at transesophageal echocardiography in structural heart disease (a cardiologist, electrophysiologist, or cardiac anesthesiologist certified in echocardiography and with experience in guiding structural heart interventions may fulfill this role ) Multidisciplinary team that includes necessary staff and expertise for preoperative evaluation, performing the LAA occlusion procedure, and acute and long-term post-procedure follow-up Active cardiothoracic surgery program with cardiac surgeons and perfusionists on site Cardiac catheterization laboratory, electrophysiolog y laboratory, or hybrid room with hemodynamic monitoring and high resolution imaging Data Collection and Quality Submission of all cases to a national registry in timely fashion, including follow-up reporting as required Institutional multi-stakeholder process for evaluation of patient selection, outcomes, and quality a Procedures using LAA occlusion devices are typically performed either by electrophysiologists, interventional cardiologists (adult or pediatric), or cardiovascular surgeons. is document uses the term "procedural specialist" to apply to members of any subspecialty who implant LAA occlusion devices. In some cases, a physician team will be composed of two operators. erefore, the procedural volume criteria and ongoing proficiency requirements apply to at least one member of the team. b LAA occlusion involving a transseptal catheterization that is primary (i.e., WATCHMAN or similar devices) or adjunctive to a percutaneous pericardial approach (i.e., LARIAT), percutaneous le ventricular assist device placement when such devices involve transseptal approach (i.e., Tandem Heart), endovascular catheter ablation within the le side of the heart, pulmonary vein stenting, balloon mitral valvuloplasty, percutaneous closure of prosthetic mitral paravalvular leaks using a transseptal approach, antegrade balloon aortic valvuloplasty, mitral valve repair using the MitraClip system or other technique involving transseptal puncture or closure, and diagnostic transseptal catheterization.

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