1 Guidance
1.1 Current evidence on the safety and efficacy of percutaneous occlusion of the left atrial appendage (LAA) for atrial fibrillation does not appear adequate for this procedure to be used without special arrangements for consent and for audit or research.
1.2 Clinicians wishing to undertake percutaneous occlusion of the LAA for atrial fibrillation should take the following actions. - Inform the clinical governance leads in their Trusts. - Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, use of the Institute's 'Understanding NICE guidance' is recommended (available from www.nice.org.uk/IPG181publicinfo). - Audit and review clinical outcomes of all patients undergoing percutaneous occlusion of the LAA for atrial fibrillation.
1.3 This procedure should only be performed in specialist units where there are arrangements for cardiac surgery in the event of complications.
1.4 Patient selection is important. This procedure should only be performed in patients for whom normal medical treatment is unsuitable.
1.5 The Department of Health runs the Central Cardiac Audit Database (CCAD); clinicians are encouraged to enter all patients undergoing percutaneous occlusion of the LAA onto this database (<url>www.ccad.org.uk</url>).
1.6 Publication of safety and efficacy outcomes will be useful. The Institute may review the procedure upon publication of further evidence.