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Updated: Nov 30, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Effectiveness and safety of same day discharge after left atrial appendage closure under moderate conscious sedation
Konstantinos Marmagkiolis1,2, Ismail Ates3, Gulcan Kose3
1HCA Northside Hospital, St Petersburg, Florida.
Insights
Same day discharge following left atrial appendage occlusion (LAAO) is safe and effective for patients without complications. Moderate conscious sedation simplifies LAAO, reducing costs and hospital stays.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for high-risk atrial fibrillation patients.
- Current LAAO procedures often require general anesthesia and overnight hospital stays.
- This study investigates same-day discharge after LAAO under moderate conscious sedation.
Purpose of the Study:
- To evaluate the safety and effectiveness of same-day discharge following LAAO.
- To assess the feasibility of performing LAAO under moderate conscious sedation (MCS).
- To explore potential benefits of MCS, including reduced costs and improved patient satisfaction.
Main Methods:
- 112 patients with elevated CHA2DS2-VASc scores underwent TEE-guided LAAO with the Watchman device under MCS.
- Patients were discharged 6 hours post-procedure after TTE evaluation.
- Clinical and procedural outcomes were prospectively evaluated.
Main Results:
- No complications arose from MCS, and no patients required conversion to general anesthesia.
- All 112 patients were discharged on the same day, 6 hours post-procedure.
- Procedural duration averaged 45 minutes, with device implant time of 14.5 minutes.
Conclusions:
- Same-day discharge following LAAO is safe and effective in uncomplicated cases.
- LAAO can be safely performed under moderate conscious sedation.
- MCS may simplify procedures, reduce costs, and shorten hospital stays, enhancing patient satisfaction.
Background:
Left atrial appendage occlusion (LAAO) using Watchman device has become a world-wide, well-established therapeutic alternative to chronic systemic oral anticoagulation in patient who are at high-risk of bleeding with paroxysmal (PAF) or chronic atrial fibrillation (Afib). Currently, LAAO procedures are performed under general anesthesia (GA) and patients stay overnight post procedure in the United States. We aimed to present the effectiveness and safety of same day discharge following LAAO under moderate conscious sedation (MCS) in patients without procedural complications.
Methods:
A total of 112 patients between August 2019 and May 2020 with elevated CHA2 DS2 VASc (median score of 3) underwent transesophageal echocardiography (TEE)-guided LAAO with FDA approved Watchman (Boston Scientific, MN) under MCS and discharged home on the same day 6 hr following their post procedural transthoracic echocardiogram (TTE) evaluations. All patients had next day TTE and follow up at the cardiology clinic. We prospectively evaluated clinical and procedural outcomes using medical records of these patients.
Results:
Among all the patients, the mean age was 83.5 ± 8.5 years, 45 (40%) were women. Procedural duration, device implant time and fluoroscopic times were 45 ± 8.6, 14.5 ± 7.8 and 10.2 ± 1.2 min, respectively. The median required dosage of propofol was 105 ± 2.8 mg. No complications arose from MCS. There was no need for conversion to GA in any of the patients during the procedure. All patients were able to be discharged 6 hr following their TTE evaluation post procedure. There were no procedural complications.
Conclusions:
Same day discharge following LAAO closure seems to be safe and effective in patients without procedural complications. LAAO can also be performed safely and effectively under moderate conscious sedation. Applying moderate conscious sedation may simplify the LAAO procedure, reduce procedural time, procedural costs and hospital stay while increasing overall patient satisfaction.
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