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Updated: Aug 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on
Lydia Fekadu Messele1, Muhammad Zia Khan2, Douglas Darden3
1Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA.
Insights
Higher stroke risk in atrial fibrillation patients undergoing left atrial appendage occlusion (LAAO) correlates with increased complications and resource use. Careful patient selection for LAAO is crucial.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Atrial fibrillation (AF) necessitates stroke risk assessment using tools like the CHA2DS2-VASc score.
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in AF patients.
- Understanding procedural outcomes based on stroke risk stratification is vital for optimizing LAAO utilization.
Purpose of the Study:
- To evaluate the association between CHA2DS2-VASc scores and outcomes following percutaneous left atrial appendage occlusion (LAAO).
- To identify specific complications and resource utilization patterns in relation to stroke risk among LAAO patients.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (2016-2020) for LAAO procedures (ICD-10 code 02L73DK).
- Stratification of 73,795 LAAO implantations into three CHA2DS2-VASc score groups: 3, 4, and ≥5.
- Assessment of outcomes including peri-procedural complications (e.g., pericardial effusion) and length of hospital stay.
Main Results:
- Patients with higher CHA2DS2-VASc scores (≥4) constituted approximately 63% of LAAO procedures.
- Increased prevalence of pericardial effusion requiring intervention was observed with higher scores (1.4% for ≥5 vs. 1.1% for 4 vs. 0.8% for 3, P<0.01).
- Multivariable analysis revealed CHA2DS2-VASc scores of 4 and ≥5 were independently associated with overall complications and prolonged length of stay.
Conclusions:
- Elevated CHA2DS2-VASc scores are linked to a higher risk of peri-procedural complications and increased resource utilization post-LAAO.
- These findings underscore the importance of meticulous patient selection for LAAO procedures.
- Further research is warranted to validate these outcomes and refine patient selection criteria.
Aims:
To determine outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO) based on the underlying stroke risk (defined by the CHA2DS2-VASc score).
Methods And Results:
Data were extracted from the National Inpatient Sample for calendar years 2016-20. Left atrial appendage occlusion implantations were identified on the basis of the International Classification of Diseases, 10th Revision, Clinical Modification code of 02L73DK. The study sample was stratified on the basis of the CHA2DS2-VASc score into three groups (scores of 3, 4, and ≥5). The outcomes assessed in our study included complications and resource utilization. A total of 73 795 LAAO device implantations were studied. Approximately 63% of LAAO device implantations occurred in patients with CHA2DS2-VASc scores of 4 and ≥5. The crude prevalence of pericardial effusion requiring intervention was higher with increased CHA2DS2-VASc score (1.4% in patients with a score of ≥5 vs. 1.1% in patients with a score of 4 vs. 0.8% in patients with a score of 3, P < 0.01). In the multivariable model adjusted for potential confounders, CHA2DS2-VASc scores of 4 and ≥5 were found to be independently associated with overall complications [adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI) 1.18-1.35, and aOR 1.88, 95% CI 1.73-2.04, respectively] and prolonged length of stay (aOR 1.18, 95% CI 1.11-1.25, and aOR 1.54, 95% CI 1.44-1.66, respectively).
Conclusion:
A higher CHA2DS2-VASc score was associated with an increased risk of peri-procedural complications and resource utilization after LAAO. These findings highlight the importance of patient selection for the LAAO procedure and need validation in future studies.
