Abstract
The watchman device is the first percutaneous left atrial appendage closure device (pLAAC) indicated in patients with non-valvular AF who cannot tolerate anticoagulation. Our study aims to assess the national trend of utilization of percutaneous left atrial appendage closure device (pLAAC) in atrial fibrillation (AF) patients and determine risk factors and predictors associated with periprocedural morbidity and mortality. Using the National Readmission Database (NRD) database between January 2016 to December 2019, patients with AF who underwent pLAAC evaluated for complications and mortality. Logistic/multivariate regression and Cox regression were used. A total of 54,903 procedures were identified from 2016-2019, mean age 75.91± 7.74, and 76.34 ± 7.42 for the years 2016 and 2019 respectively, 58.23% were male. The total volume of procedures across the board increased consistently each year being 4671 in 2016, 9389 in 2017, 12,698 in 2018, and 25,361 in 2019. Procedures were done in patients with higher number of chronic comorbidities including Prior myocardial infarction (MI), percutaneous coronary intervention, coronary artery disease, heart failure, hypertension, valvular disease, anemia, obesity, chronic lung disease, chronic kidney disease, diabetes, and obstructive sleep apnea (P<0.001). The rate of complications showed a trend toward reduction from 8.2% in 2016 to 7.1% in 2019 (Ptrend=0.006). Bleeding-related complications were significantly reduced for the year 2019 compared with 2016 (4.7% vs 5.5% respectively, Ptrend=0.024). This was primarily driven by fewer hemorrhagic strokes, major bleeds, and blood transfusion procedures. Hospitals with a higher volume of procedures had decreased mortality rates (aOR:0.89, CI0.85-0.93, P<0.0001). Mortality rates did not differ between different years (0.2%). This large NRD study shows there is an inverse relationship between hospital volume and odds of mortality for pLAAC procedures. The number of patients with chronic comorbidities undergoing pLAAC is increasing. Complication rates have been consistently decreasing. Despite this, there was no significant change in mortality.
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