Related Experiment Video
Updated: Oct 5, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Safety, Efficacy, and Cost-Effectiveness of Same-Day Discharge for Left Atrial Appendage Occlusion
Luis Augusto Palma Dallan, Hiram G Bezerra, Anthony Cochet
1University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH, 44106 USA. Steven.Filby@UHhospitals.org.
Insights
Same-day discharge for left atrial appendage occlusion (LAAO) is safe and feasible. This approach reduces hospital stays and costs, potentially becoming a new standard for LAAO procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Economics
Background:
- Percutaneous left atrial appendage occlusion (LAAO) using the Watchman device is FDA-approved for stroke prevention in nonvalvular atrial fibrillation.
- A same-day discharge protocol (SDDP) was implemented during the COVID-19 pandemic to optimize resource use and minimize in-hospital virus exposure.
Purpose of the Study:
- To evaluate the safety, feasibility, and cost-effectiveness of the SDDP for LAAO procedures.
- To compare outcomes of SDDP with conventional discharge strategies.
Main Methods:
- Prospective analysis of 142 patients undergoing LAAO.
- 119 patients received conventional discharge; 23 patients underwent SDDP.
- Pre-procedural planning included cardiac computed tomography angiography (CTA) and intracardiac echocardiogram (ICE) guidance.
Main Results:
- All LAAO procedures were successful with no significant difference in procedural complications or in-hospital adverse events between groups.
- The SDDP group experienced a slightly longer procedure time but a significantly reduced length of stay.
- SDDP was associated with a 15% reduction in total healthcare costs.
Conclusions:
- Same-day discharge after LAAO is a safe and feasible strategy.
- A protocol incorporating CTA planning, ICE guidance, and conscious sedation can decrease hospital resource utilization and lower costs.
- SDDP may represent a new standard of care for LAAO.
Background:
Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is FDA approved for stroke prevention in patients with nonvalvular atrial fibrillation who have an appropriate indication. During the COVID-19 pandemic, a same-day discharge protocol (SDDP) was employed to improve resource utilization, relieve hospital occupation, and reduce the possible risk of in-hospital virus transmission.
Objectives:
We sought to analyze the safety, feasibility, and cost effectiveness for SDDP in patients receiving LAAO.
Methods:
A prospective analysis of 142 consecutive patients, 119 treated prior to SDDP and 23 who underwent SDDP following LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intracardiac echocardiogram (ICE). Procedures were performed in a single, large academic hospital in the United States. In-hospital and 45-day procedural success, adverse events, length of procedure, and length-of-stay were evaluated.
Results:
Baseline patient characteristics including mean CHA2DS2VASc scores and mean HAS-BLED scores were similar in both groups. All procedures were successful. There was no significant difference in rates of procedural complications or in-hospital adverse events. The mean procedure time in the SDDP group was 11 minutes longer than in the conventional group (62.1 ± 5.9 vs 51.1 ± 21; P=.01). Outcomes at 45-day follow-up were similar. SDDP was associated with a reduced length of stay compared with conventional strategy and a 15% reduction in total costs.
Conclusions:
Same-day discharge strategy for LAAO appears safe, feasible and could become the new standard approach for LAAO. A protocol including CTA pre-procedural planning, ICE-guided deployment and conscious sedation reduces hospital occupation and lowers costs.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:28Acute Coronary Syndrome IV: Interprofessional Care