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Updated: Sep 17, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Outcomes of same-day discharge after left atrial appendage closure with and without pre-discharge transthoracic
Prasana Ramesh1, Uneza Khawaja1, Chidubem Ezenna1
1UMass Chan Medical School - Baystate Campus, Massachusetts, United States of America.
Insights
Routine transesophageal echocardiography (TTE) after left atrial appendage closure (LAAC) did not significantly impact 45-day readmission rates for patients discharged the same day. A selective approach to post-procedure imaging may be more appropriate, considering costs and resource use.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left Atrial Appendage Closure (LAAC) is performed in patients with nonvalvular atrial fibrillation contraindicated to anticoagulation.
- Current guidelines recommend routine transesophageal echocardiography (TTE) before same-day discharge after LAAC.
- This study evaluated outcomes associated with post-procedure TTE in patients undergoing LAAC with same-day discharge.
Purpose of the Study:
- To determine if routine post-procedure TTE influences 45-day hospitalization rates after LAAC in patients discharged on the same day.
- To compare readmission rates between patients who received a TTE and those who did not before same-day discharge.
Main Methods:
- A retrospective observational study utilizing an institutional LAAC registry.
- Comparison of patients discharged same-day who underwent TTE versus those discharged without TTE.
- Primary outcome: 45-day readmission for any reason post-discharge.
Main Results:
- 350 patients discharged without TTE and 60 patients with TTE were analyzed.
- Readmission rates were 4/60 in the TTE group and 33/350 in the No TTE group.
- The risk ratio for readmission without TTE versus with TTE was 1.41 (95% CI 0.52-3.85, p=0.25); no 45-day mortality occurred.
Conclusions:
- Routine pre-discharge TTE did not significantly affect 45-day readmission rates for LAAC patients discharged same-day.
- The absence of a significant clinical benefit, coupled with TTE costs and resource utilization, suggests a more selective imaging approach.
- Consideration should be given to tailoring post-procedural imaging based on individual patient risk factors and procedural findings.
Background:
Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo left atrial appendage closure. SCAI/HRS consensus recommends routine post-procedure transthoracic echocardiography (TTE) before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.
Methods:
We performed a retrospective observational study using the data from our institutional LAAC registry. We compared patients discharged on the same day after the procedure who underwent a TTE vs patients who were discharged without a TTE. The primary outcome studied was 45-day readmission for any given reason from the day of discharge.
Results:
In a cohort of patients who were discharged on the same day, 350 did not undergo post-procedure TTE, and 60 underwent TTE. 33 patients were readmitted in the TTE group, and 4 patients were readmitted in the No TTE group. The RR for readmission without vs. with pre-discharge TTE was 1.41 (95 % CI 0.52-3.85, p = 0.25). No 45-day mortality occurred in either study group.
Conclusion:
For patients undergoing LAAC with same-day discharge, routine TTE before discharge did not significantly influence 45-day readmission rates. Given the absence of clinical benefit but the presence of TTE costs and resource use, a more selective approach to post-procedural imaging should be considered.
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