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Updated: Jun 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical
William Hickman1, Rachel S Dada2, Dylan Thibault3
1School of Medicine, West Virginia University, Morgantown, West Virginia, United States.
Insights
Monitored anesthesia care (MAC) for left atrial appendage closure (LAAC) increased slightly from 2017-2021, though general anesthesia (GA) remains more common. Anesthetic choice for LAAC procedures varies by geographic region.
Area of Science:
- Cardiology
- Anesthesiology
- Medical Devices
Background:
- Left atrial appendage closure (LAAC) offers stroke prevention for atrial fibrillation patients unsuitable for anticoagulation.
- General anesthesia (GA) has been traditional for LAAC, often due to transesophageal echocardiography requirements.
Purpose of the Study:
- To compare trends in monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC.
- To identify factors influencing the choice between MAC and GA for LAAC procedures.
Main Methods:
- Retrospective analysis of multi-institutional data from the National Anesthesia Clinical Outcomes Registry (2017-2021).
- Statistical analysis included t-tests, Mann-Whitney U tests, Chi-square tests, Fisher's exact test, and multivariate logistic regression.
Main Results:
- Monitored anesthesia care (MAC) was used in 1.8% of 19,395 LAAC procedures, with usage trending upward (2017-2021).
- MAC patients were more likely to have higher ASA status and be treated in rural Southern centers with lower procedure volumes.
- Patients in Western US regions had significantly lower odds of receiving MAC compared to those in the Northeast.
Conclusions:
- General anesthesia (GA) remains the predominant anesthetic for percutaneous transcatheter LAAC.
- A statistically significant, albeit small, increase in MAC utilization for LAAC was observed from 2017 to 2021.
- Geographic location is a significant factor influencing anesthetic management for LAAC procedures.
Context:
Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.
Aims:
Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.
Settings And Design:
Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.
Material And Methods:
Retrospective data analysis from 2017-2021.
Statistical Analysis Used:
Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.
Results:
A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).
Conclusions:
While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
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