PO-02-220 IMPROVED EFFICIENCY OF COMBINED CRYOBALLOON PVI AND WATCHMAN COMPARED TO SEPARATE PROCEDURES

Abstract

There is a significant amount of pressure in EP labs across the country to maximize lab efficiency. Elective pulmonary vein isolation (PVI) and left atrial appendage occlusion (LAAO) devices such as Watchman are being scheduled out several months at most centers. To that end, we have sought to reduce the amount of repeat procedures in select patients by combining cryo PVI ablation with LAAO device implant. This is also beneficial from a patient satisfaction perspective and a safety perspective (e.g. one time groin access, transseptal puncture, and general anesthesia). The goal of this study was to look at total room and procedure times for isolated PVI and LAAO implant cases versus combining the two procedures. We retrospectively analyzed patients from our institution who had a combined PVI and Watchman FLX device placement in the last two years. Forty-two patients underwent the combined procedure. To allow a more direct comparison, patients who received additional lesions beyond PVI were excluded from our analysis. These 18 patients were compared to the last 50 patients who had an isolated PVI and the last 50 patients who had an isolated Watchman implant. Patients were selected for the combined procedure based on clinical criteria and operator preference. For each patient we reviewed the total room time (patient entering the EP lab until exit), procedural time (venous access to sheath removal), patient characteristics, and adverse events. All cases were done under general anesthesia with TEE. The average room time for isolated PVI was 180 minutes, isolated Watchman 114, and combined procedure 209. Procedure time for PVI was 91 minutes, Watchman 35, and the combined procedure 103. Adding 30 minute room turnover, the separate procedures would require 324 min, compared to 209 min for the combined procedure. The time savings of 115 min is the same room time required for an additional standalone Watchman. Patient characteristics are listed in the table below. There were no major adverse events in any of the groups. The implantation of Watchman device in addition to PVI increased room time by 30 minutes and added 12 minutes to the procedural time, without any adverse events. Combining these procedures in a select group of patients may safely and efficiently improve time resources. Any potential reduction in reimbursement for the combined procedures can be offset by the ability to perform one or more additional procedures in the room within the same time period.Tabled 1PVIWatchmanPVI + WatchmanAge63.376.773.4% Male747869CHADS2 VASc (mean)2.14.03.8% LVEF555653Room time (min)179114209Procedure time (min)9034102 Open table in a new tab