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Updated: May 5, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Incidence and Predictors of Adverse Events Among Patients Awaiting Left Atrial Appendage Closure
Justin Pieper1, Sapan Bhuta1, Michael Poliner1
1Electrophysiology Section, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Delays in left atrial appendage closure (LAAC) increase adverse event risk. High HAS-BLED scores also predict complications, warranting expedited procedures for high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Limited data exists on optimal timing for Left Atrial Appendage Closure (LAAC).
- The impact of procedural delays on adverse outcomes in patients awaiting LAAC is not well-defined.
Purpose of the Study:
- To determine the incidence and predictors of adverse events in patients undergoing LAAC.
- To evaluate risks associated with the waiting period before LAAC.
Main Methods:
- A single-center retrospective study analyzed 265 patients who underwent LAAC between January 2017 and March 2020.
- Adverse events (bleeding, anemia, thromboembolism, death) were tracked from decision-to-procedure.
- Multivariate analysis identified predictors of adverse events.
Main Results:
- The median time from decision to insurance approval was 18 days, and from approval to LAAC was 44 days.
- Six percent (17/265) of patients experienced an adverse event, primarily bleeding/anemia (15 cases).
- Increased time to LAAC (OR 1.31) and higher HAS-BLED scores (OR 1.67) were significant predictors of adverse events.
Conclusions:
- Prolonged waiting times for LAAC are associated with a higher risk of adverse events.
- Higher HAS-BLED scores also predict increased risk during the LAAC waiting period.
- Expedited LAAC procedures are recommended for high-risk individuals.
Background:
There is a paucity of data regarding the optimal timing of left atrial appendage closure (LAAC) and whether scheduling delays increase the risk for adverse outcomes.
Objectives:
This study sought to assess the incidence and predictors of adverse events among patients awaiting LAAC.
Methods:
This single-center retrospective study assessed all patients who underwent LAAC from January 2017 to March 2020. The primary study endpoints were the rate and characteristics of adverse events occurring from the time of initial shared decision to pursue LAAC until the time of LAAC. Adverse events were defined as clinically significant bleeding or anemia, thromboembolic complications, or death. Patients were censored after successful closure or the first adverse event.
Results:
Two hundred and sixty-five patients underwent LAAC with demographics notable for age 73.5 ± 8.1 years, 98 (37%) females, left ventricular ejection fraction 52.3% ± 10.4%, CHA2DS2-VASc 4.8 ± 1.4, and HAS-BLED 3.2 ± 1.2. Median time from shared decision to insurance approval and insurance approval to LAAC were 18 (IQR 28) and 44 (IQR 40) days, respectively. Seventeen (6%) patients suffered an adverse event, including 15 (88%) cases of bleeding or anemia and 2 (12%) cases of thromboembolism. Multivariate analysis demonstrated that increased time to LAAC (odds ratio [OR] 1.31, 95% confidence interval [CI] [1.15, 1.50], p < 0.001) and higher HAS-BLED score (OR 1.67, CI [1.11, 2.59], p = 0.017) were associated with significantly increased risk for adverse events.
Conclusion:
Prolonged time to LAAC and higher HAS-BLED score portend an increased risk for adverse events while awaiting LAAC. Expedited closure is warranted in high-risk patients.
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