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Related Concept Videos

Cardiac Catheterization III: Left Heart Catheterization01:24

Cardiac Catheterization III: Left Heart Catheterization

Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Related Experiment Video

Updated: Jun 18, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

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Procedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion.

Daniel J Friedman1, Chengan Du2, Sarah Zimmerman2

  • 1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.J.F., S.V., A.S.K., J.P.P.).

Circulation. Cardiovascular Interventions
|June 18, 2024
PubMed
Summary

Higher hospital and physician WATCHMAN volumes improve left atrial appendage occlusion success. The newer WATCHMAN FLX device shows better outcomes and less volume-outcome variation.

Keywords:
hospitalsleft atrial appendage closurelinear modelsphysiciansregistries

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Volume-outcome relationships are established for many cardiovascular procedures, guiding minimum volume thresholds.
  • The specific association between procedural volume and outcomes for left atrial appendage occlusion (LAAO) remains poorly understood.
  • This study investigates the impact of hospital and physician procedural volume on LAAO success.

Purpose of the Study:

  • To determine the relationship between hospital and physician volume and the success of WATCHMAN left atrial appendage occlusion procedures.
  • To evaluate this relationship specifically for the WATCHMAN FLX device.

Main Methods:

  • Analysis of 87,480 WATCHMAN procedures from the National Cardiovascular Data Registry LAAO Registry (January 2019 to October 2021).
  • Utilized three-level hierarchical generalized linear models to assess adjusted relationships.
  • Procedural success defined as device release with peridevice leak <5 mm and no in-hospital major adverse events.

Main Results:

  • Overall procedural success rate was 94.2% across 693 hospitals.
  • Lower hospital volumes (Q1, Q2) were associated with significantly lower procedural success compared to the highest volume quartile (Q4).
  • Lower physician volumes (Q1, Q2, Q3) were also significantly associated with reduced procedural success compared to Q4.
  • The WATCHMAN FLX device showed attenuated volume-outcome relationships with modest outcome differences across volume quartiles.

Conclusions:

  • Higher hospital and physician volumes for WATCHMAN procedures are linked to increased procedural success.
  • The transition to the WATCHMAN FLX device correlated with improved procedural success and reduced outcome variability across volume levels.
  • Understanding device-specific volume-outcome relationships is crucial for optimizing left atrial appendage occlusion procedures.