Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016–2019 national readmission database. Issue 2 (9th November 2022)

• Record Type: Journal Article
• Authors: Pasupula, Deepak Kumar; Siddappa Malleshappa, Sudeep K; Munir, Muhammad B; Bhat, Anusha Ganapati; Anandaraj, Antony; Jakkoju, Avaneesh; Spooner, Michael; Koranne, Ketan; Hsu, Jonathan C; Olshansky, Brian; Camm, A John
• Is Part Of: Europace. Volume 25:Issue 2(2023)
• Page Start: 390
• Page End: 399
• Publication Date: 2022-11-09
• Subjects: LAAO – Left Atrial Appendage Occlusion -- CA – Percutaneous Catheter-directed Atrial Fibrillation Ablation -- MACE – Major Adverse Cardiovascular Events -- NRD – National Readmission Database; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac181
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: The safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients. Methods and results: In this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients ( n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only ( n = 407, 5.3%) or CA-only patients ( n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%). Conclusion: We report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients.