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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Comparative Outcomes of Left Atrial Appendage Occlusion Device Implantation in Atrial Fibrillation Patients With

Amanda Nguyen1, Muhammad Zia Khan2, Waleed Alruwaili3

  • 1Department of Medicine, University of California Davis Medical Center, Sacramento, California, USA.

Pacing and Clinical Electrophysiology : PACE
|February 25, 2026
PubMed

Insights

Left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) patients with lower stroke risk (CHA2DS2-VASc < 3) is linked to fewer complications and lower hospitalization costs. These findings suggest potential shifts in LAAO therapy indications for stroke prevention.

Area of Science:

  • Cardiology
  • Medical Devices
  • Health Economics

Background:

  • Current guidelines recommend oral anticoagulation for stroke prevention in atrial fibrillation (AF) patients with CHA2DS2-VASc score ≥2.
  • Centers for Medicare & Medicaid Services (CMS) policy currently reimburses left atrial appendage occlusion (LAAO) for patients with a CHA2DS2-VASc score ≥3.

Purpose of the Study:

  • To evaluate differences in outcomes and complications of LAAO therapy in AF patients stratified by CHA2DS2-VASc score (≥3 vs. <3).
  • To assess the impact of stroke risk on LAAO procedural complications, inpatient outcomes, and resource utilization.

Main Methods:

  • Utilized the National Inpatient Sample (NIS) database from 2016-2020, identifying LAAO device implantations using ICD-10 codes.
  • Stratified the study population into two groups based on stroke risk: CHA2DS2-VASc score ≥3 and <3.
  • Assessed endpoints including procedural complications, inpatient outcomes, and healthcare resource utilization.

Main Results:

  • A total of 73,795 LAAO devices were implanted in patients with CHA2DS2-VASc ≥3 and 15,500 in patients with CHA2DS2-VASc <3.
  • Patients with CHA2DS2-VASc <3 exhibited significantly lower crude overall (6.9% vs. 9.9%) and major (4.5% vs. 6.2%) complications.
  • Multivariable analysis confirmed that CHA2DS2-VASc <3 was associated with reduced overall complications (aOR 0.84), major complications (aOR 0.90), and hospitalization costs (aOR 0.95).

Conclusions:

  • LAAO device implantation in AF patients with a CHA2DS2-VASc score <3 is associated with lower complication rates and reduced hospitalization costs.
  • These findings warrant further investigation in large randomized trials to inform clinical practice guidelines for LAAO use in stroke prevention.
  • The data suggest a potential role for LAAO in lower-risk AF patient populations.
Abstract

Keywords:
atrial fibrillationcomplicationsleft atrial appendage occlusionoutcomesstroke risk

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