CPT® Code 33340

Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation

Percutaneous transcatheter closure of the left atrial appendage (LAA) is a minimally invasive procedure designed to reduce the risk of thrombus formation and stroke in patients with non-valvular atrial fibrillation (NVAF) who are at high risk and for whom oral anticoagulation therapy is not suitable. The LAA is a small, pouch-like structure located in the left atrium of the heart, which can be a source of blood clots that may lead to strokes. The anatomy of the LAA can vary significantly among individuals, categorized into four distinct morphological types: the 'chicken wing' type, characterized by a bend in the proximal end of the dominant lobe; the 'windsock' type, which features a long main lobe exceeding 4 cm; the 'cauliflower' type, which has a limited length of less than 4 cm without forked lobes; and the 'cactus' type, which has a dominant central lobe with secondary extensions. The unique shape and size of the LAA, along with the patient's hemodynamic status and rhythm, play a crucial role in determining the appropriate endocardial implant device for closure. The procedure involves accessing the femoral vein, navigating through the heart using fluoroscopic guidance, and employing various catheters and guidewires to accurately position the implant within the LAA. This technique aims to effectively seal off the LAA, thereby minimizing the risk of stroke while avoiding the complications associated with long-term anticoagulation therapy.