Background
Percutaneous left atrial appendage closure (pLAAC) emerged as an option for stroke
prevention in patients with atrial fibrillation ineligible for long-term anticoagulation.
Real-world data on pLAAC's in-hospital and 30-day readmission measures are limited.
Objective
We sought to report the nationwide incidence of the above outcomes using 2016 claims
data.
Methods
We used the National Inpatient Sample for in-hospital outcomes and Nationwide Readmissions
Database for readmissions. We identified hospitalizations with a primary diagnosis
of atrial fibrillation and pLAAC procedure by using International Classification of Diseases, Tenth Revision codes and compared the outcomes mentioned above between the endocardial and epicardial
cohorts. Statistical analyses were performed using R 3.3.2.
Results
Among 5480 pLAAC procedures (endocardial: 5145; epicardial: 335), the in-hospital
mortality was 0.3%. Endocardial left atrial appendage closure (LAAC) had lower complications
(8.5% vs 25.4%; P < .001) and shorter length of stay median [interquartile range] 1 [1–1] day vs 2
[1–3] days; P < .001) but higher hospitalization cost (24.13 [18.45–30.17] × 1000 dollars vs 21.21
[14.03–27.86] × 1000 dollars; P = .016). The most common complications include pericardial (endocardial vs epicardial:
3% vs 10.4%; P < .001) and renal failure (1.4% vs 6.0%; P = .004). Epicardial LAAC had higher 30-day unplanned readmissions (19.5% vs 8.3%;
P = .001), with the most common reason being pericarditis and/or effusion (33.9%).
Conclusion
Endocardial LAAC had lower complications and 30-day readmissions but higher hospitalization
cost. Although epicardial LAAC showed higher complications, given recent improvements
in its technique, and postprocedural care demonstrated a significant reduction in
pericardial complications, more contemporary data comparing these outcomes are needed.
Keywords
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Article info
Publication history
Published online: September 17, 2019
Footnotes
Dr Lakkireddy has received honoraria from Biosense Webster, Bristol-Myers Squibb, Northeast Scientific, Jansen, Pfizer, and Abbott and is a consultant to SentreHEART and Abbott. Dr Bartus is a consultant to SentreHEART. Dr Mansour has received research grants from Boston Scientific, Biosense Webster, and Abbott and serves as a consultant to Boston Scientific. Dr Heist has received research grant support from Abbott and Boston Scientific and honoraria from Medtronic, Boston Scientific, Abbott, Biotronik, and Johnson & Johnson as well as serves as a consultant to Pfizer Pharmaceutical. The rest of the authors report no conflicts of interest.
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