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Updated: Jun 13, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Outcomes of left atrial appendage occlusion with atrial fibrillation ablation: a real-world analysis from the
Muhammad Zia Khan1, Justin Lim Devera2, Waleed Alruwaili3
1Division of Cardiology, Deborah Heart and Lung Center, Brown Mills, NJ, USA.
Insights
Concomitant atrial fibrillation (AF) ablation with left atrial appendage occlusion (LAAO) increases complication risks and healthcare costs. This combined procedure, compared to LAAO alone, leads to more adverse events and greater resource utilization in real-world settings.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- The safety and economic impact of combining atrial fibrillation (AF) ablation with left atrial appendage occlusion (LAAO) are not well-established.
- Understanding these outcomes is crucial for clinical decision-making and healthcare resource allocation.
Purpose of the Study:
- To evaluate the real-world safety and resource utilization of patients undergoing LAAO with concomitant AF ablation.
- To compare outcomes between patients receiving LAAO with AF ablation versus LAAO alone.
Main Methods:
- Utilized the National Inpatient Sample database (2016-2022) with International Classification of Diseases-Tenth Revision codes.
- Identified and compared patient cohorts undergoing LAAO with and without AF ablation.
- Assessed procedural complications, length of stay, discharge disposition, and hospitalization costs.
Main Results:
- Concomitant AF ablation with LAAO showed significantly higher rates of overall and major complications.
- Patients undergoing the combined procedure experienced increased non-home discharge, prolonged hospital stays, and elevated costs.
- Higher incidences of pacemaker implantation, acute kidney injury, and non-ST elevation myocardial infarction were observed in the combined procedure group.
Conclusions:
- In real-world US settings, performing AF ablation concurrently with LAAO is linked to increased overall and major complications.
- The combined approach also results in greater resource utilization, including longer hospital stays and higher costs.
- These findings suggest a need for careful consideration of risks and benefits when opting for combined AF ablation and LAAO.
Background:
The safety and cost of concomitant atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) procedure remain unknown.
Objective:
The study sought to determine real-world outcomes of AF patients who underwent LAAO with ablation.
Methods:
The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent LAAO with and without AF ablation during the years 2016-2022. The outcomes assessed included procedural complications and resource utilization.
Results:
LAAO with AF ablation was associated with a higher rate of overall (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.37-1.74), major complications (OR 1.38, 95% CI 1.18-1.60), non-home discharge (OR 1.55, 95% CI 1.23-1.96), prolonged length of stay > 1 day (OR 3.21, 95% CI 2.92-3.52), and increased hospitalization costs as defined by median cost > $25,926 (OR 19.42, 95% CI 16.21-23.25) when compared to LAAO alone after adjustment for potential confounding variables. Patients who underwent LAAO with ablation were also more likely to receive pacemaker implantation (3.6% vs 0.2%, P < 0.001) and experience acute kidney injury (3.9% vs 2.1%, P < 0.001) and non-ST elevation myocardial infarction (3.7% vs 1.5%, P < 0.001).
Conclusion:
In a large, contemporary, real-world study of LAAO procedures in the USA, concomitant AF ablation was associated with a higher rate of overall and major complications and an increased resource utilization.
