Multimodality imaging for pre-, intra-, and postprocedural guidance of left atrial appendage closure: a European Left Atrial Appendage Closure Club (ELAACC) expert consensus statement

Left atrial appendage closure (LAAC) is an established alternative for stroke prevention in patients with non-valvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation. Imaging is central to procedural success and safety, yet variability in acquisition, measurement, and reporting contributes to inconsistent workflows and outcomes among centres. This expert consensus document from the European Left Atrial Appendage Closure Club provides a unified framework for pre-, intra-, and postprocedural imaging in LAAC with the aim of reducing variability, standardising workflows, and improving clinical reproducibility. The consensus emphasises high-quality image acquisition, reproducible measurements, and the prioritisation of three-dimensional (3D) imaging techniques and multiplanar reconstruction. Standardised terminology, core anatomical parameters, and device-oriented requirements are defined to support consistent procedural planning and device selection. Intraprocedural recommendations focus on real-time guidance using 3D transoesophageal echocardiography, intracardiac echocardiography, and fusion imaging for transseptal puncture, device alignment, deployment, and sealing assessment. Postprocedural guidance harmonises echocardiographic and cardiac computed tomography criteria and proposes structured follow-up pathways for the assessment of device-related thrombus, peridevice leak, and device stability. By promoting consistent nomenclature and structured, evidence-informed imaging strategies across the entire LAAC pathway, this consensus aims to enhance procedural safety, improve reproducibility, and support uniform, high-quality LAAC practice across centres.