Operator Experience and Outcomes after Transcatheter Left Atrial Appendage Occlusion with the Watchman Device

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Transcatheter left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for atrial fibrillation (AF) patients.
• Volume-outcome relationships for LAAO at the individual operator level remain understudied.

Purpose of the Study:

• To investigate the association between operator volume and outcomes in LAAO procedures.
• To determine if operator specialty (Interventional Cardiologist vs. Electrophysiologist) influences LAAO outcomes.

Main Methods:

• A retrospective analysis of 425 consecutive LAAO procedures performed by seven operators.
• Operators were categorized into tertiles based on annual case volume (<40, 41-80, >80 cases/year).
• Primary outcome was major adverse cardiac events (MACE); secondary outcome was technical success. Statistical analyses included unadjusted and adjusted models.

Main Results:

• No significant difference in MACE was observed across operator volume tertiles (p=0.83 unadjusted, p=0.45 adjusted).
• MACE rates were similar between Interventional Cardiologists and Electrophysiologists (p=0.24 unadjusted, p=0.33 adjusted).
• Technical success rates did not differ significantly among volume groups or operator specialties.

Conclusions:

• Operator experience, defined by case volume, does not appear to affect MACE or technical success in LAAO.
• These findings suggest a favorable learning curve for LAAO, with high technical success attainable by operators with lower case volumes.