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Updated: Dec 19, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Evaluation of Effectiveness and Safety of Left Atrial Appendage Closure Under Moderate Conscious Sedation
Ismail Ates, Konstantinos Marmagkiolis, Gulcan Kose
111800 Carmel Creek Road, San Diego, CA 92130 USA. cilingiroglumehmet@gmail.com.
Insights
Left atrial appendage closure (LAAC) with the Watchman device is safe and effective under moderate conscious sedation (MCS). This approach simplifies procedures, reduces costs, and improves patient satisfaction compared to general anesthesia.
Area of Science:
- Cardiology
- Medical Devices
- Anesthesiology
Background:
- Left atrial appendage closure (LAAC) using the Watchman device is an alternative to oral anticoagulation for high-risk atrial fibrillation (Afib) patients.
- LAAC procedures in the U.S. are typically performed under general anesthesia (GA).
Purpose of the Study:
- To evaluate the feasibility, effectiveness, and safety of performing LAAC under moderate conscious sedation (MCS).
Main Methods:
- 112 patients with elevated CHA2DS22VASc scores underwent TEE-guided LAAC with the Watchman device under MCS.
- Clinical and procedural outcomes were prospectively evaluated.
Main Results:
- The procedure duration was 45 ± 8.6 minutes, with a device implant time of 14.5 ± 2.8 minutes.
- No complications related to MCS were observed, and no patients required conversion to GA.
- The median propofol dose was 101 ± 2.8 mg.
Conclusions:
- LAAC can be safely and effectively performed under moderate conscious sedation.
- Using MCS may simplify the LAAC procedure, reduce costs, and enhance patient satisfaction.
Background:
Left atrial appendage closure (LAAC) using the Watchman device has become a well-established, world-wide therapeutic alternative to oral anticoagulation in high-risk patients for bleeding with paroxysmal, persistent atrial fibrillation (Afib) or permanent Afib. Currently, in the United States, LAAC procedures are performed under general anesthesia (GA). We present the feasibility, effectiveness, and safety of LAAC under moderate conscious sedation (MCS).
Methods:
A total of 112 patients with elevated CHA2DS22VASc (median score of 3) between November 2018 and November 2019 underwent transesophageal echocardiography (TEE)-guided LAAC with the FDA-approved Watchman LAAC device (Boston Scientific) under MCS. We prospectively evaluated clinical and procedural outcomes using medical records of these patients.
Results:
Mean patient age was 73.5 ± 4.5 years and 45 (40%) were women. Procedural duration, device implant time, and fluoroscopic times were 45 ± 8.6 minutes, 14.5 ± 2.8 minutes, and 10.2 ± 1.2 minutes, respectively. The median required dosage of propofol was 101 ± 2.8 mg. No complications were observed from MCS. There was no need for conversion to GA in any of the patients during the procedure.
Conclusions:
LAAC is safe and effective when performed under MCS. Thus, applying MCS may simplify the LAAC procedure, as well as reduce procedural time and procedural costs, while increasing overall patient satisfaction.
