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Updated: May 12, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Association of Physician Certification and Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion
Amit N Vora1, Lucy A Pereira2, Chengan Du2
1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Left atrial appendage occlusion (LAAO) procedures show similar safety and efficacy regardless of whether the operator is an interventional cardiologist or electrophysiologist. This finding supports broad access to LAAO for eligible patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Percutaneous left atrial appendage occlusion (LAAO) is a key treatment for patients with atrial fibrillation unsuitable for long-term anticoagulation.
- The impact of operator subspecialty (interventional cardiology vs. electrophysiology) on LAAO outcomes remains unclear.
Purpose of the Study:
- To compare left atrial appendage occlusion (LAAO) outcomes based on physician certification: interventional cardiology (IC) versus electrophysiology (EP).
- To analyze procedural safety and efficacy in relation to operator subspecialty using registry data.
Main Methods:
- Analysis of 91,711 LAAO procedures (Watchman FLX, Amulet devices) from 2020-2022 in the NCDR LAAO Registry.
- Stratification of patients by primary operator certification (EP vs. IC) and comparison of outcomes including major adverse events (MAE), mortality, ischemic stroke, and major bleeding.
- Multivariable Cox proportional hazards regression was used to adjust for potential confounders.
Main Results:
- Electrophysiologists (EPs) were more likely to use intracardiac echocardiography and had lower radiation exposure compared to interventional cardiologists (ICs).
- In-hospital death and MAE were similar between EP and IC operators (0.1% vs. 0.1% and 1.5% vs. 1.6%, respectively).
- At 45 days, multivariable analysis showed no significant difference in death (HR 1.03) or MAE (HR 0.97) based on operator certification.
Conclusions:
- Contemporary left atrial appendage occlusion (LAAO) demonstrates favorable safety and low complication rates.
- Procedural outcomes for LAAO are comparable between electrophysiology and interventional cardiology specialists after multivariable adjustment.
- Ensuring continued access to LAAO technology by both EP and IC specialists is crucial for eligible patients.
Background:
Percutaneous left atrial appendage occlusion (LAAO) is indicated in patients with atrial fibrillation for whom long-term oral anticoagulation is contraindicated. Whether outcomes are different based on operator certification (interventional cardiology [IC] vs electrophysiology [EP]) is unclear.
Objectives:
The authors sought to compare LAAO outcomes by physician certification (EP vs IC) in the NCDR (National Cardiovascular Data Registry) LAAO Registry.
Methods:
We identified patients from 2020 to 2022 undergoing implantation of a Watchman FLX (Boston Scientific) or Amulet (Abbott Cardiovascular) LAAO device and stratified patients by primary operator certification. Outcomes of interest included: 1) any major adverse event (MAE); 2) mortality; 3) ischemic stroke; and 4) major bleeding during the initial hospitalization and at 45 days. We performed multivariable Cox proportional hazards regression analysis to determine the risk of adverse events by physician certification.
Results:
A total of 1,638 physicians (57% electrophysiologists) performing 91,711 procedures during the study period were included. EPs were more likely to use intracardiac echocardiography (25.2% vs 9.7%; P < 0.001) and had lower radiation total (235 mGy vs 305 mGy; P < 0.001). EPs were more likely than ICs to discharge patients on DOAC + aspirin, whereas ICs were more likely to discharge patients on single or dual antiplatelet therapy (all P < 0.001). In-hospital death (0.1% vs 0.1%; P = 0.46) and MAE (1.5% vs 1.6%; P = 0.42) were similar by physician certification. At 45 days, there was no difference in death (HRdeath: 1.03; 95% CI: 0.89-1.20) or MAE (HRMAE: 0.97; 95% CI: 0.91-1.03) after multivariable regression.
Conclusions:
Contemporary LAAO is safe with low rates of procedural complications and no significant differences in procedural outcomes by operator subspecialty after multivariable adjustment. Continued utilization of technology by EPs and ICs is necessary to allow for broad access to this treatment for eligible patients.
