1347.1 – Transcatheter occlusion of the left atrial appendage for patients with non-valvular atrial fibrillation (resubmission)

New MBS item.

The medical service is the percutaneous insertion of a left atrial appendage closure (LAAC) device to occlude the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation (NVAF). The LAA is the primary source for thromboembolism in patients with NVAF. The procedure aims at preventing stroke and systemic thromboembolism by closing off the LAA permanently to avoid the formation and migration of emboli to the brain.

The implantation procedure uses standard transseptal techniques. The access sheath and delivery catheter permit device placement in the LAA via femoral venous access and inter-atrial septum crossing into the left atrium. The device is unsheathed when in the appropriate position.

The procedure is performed under local or general anaesthesia by an interventional cardiologist or cardiac electrophysiologist in a catheterisation laboratory under guidance of fluoroscopy and TOE. The procedure takes approximately 60 minutes.

Type: Therapeutic

Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and a key risk factor for ischaemic strokes. A thrombus can form when blood becomes trapped in the LAA due to fibrillation. When the thrombus becomes dislodged it migrates through the arterial system towards the brain, resulting in vascular occlusion from the thromboembolism which may cause an ischemic stroke. Ischemic strokes can lead to a large number of complications including hemi-paralysis, speech deficits, dysphasia, and even death.

• PASC meeting: -
• ESC meeting: 9 June 2016
• MSAC meeting: 28 July 2016

Note: for PICO confirmation, refer to application 1347.