Safety and Clinical Outcomes of a Complete "Minimalist" Left Atrial Appendage Occlusion Pathway.

Abstract

The standard approach to catheter based left atrial appendage occlusion (LAAO) involves trans-esophageal echocardiography (TEE) guided screening and placement, and procedural general anesthesia requiring overnight stay. In pursuit of improved patient experience and reduced cost, streamlined approaches in each phase of care have been explored. However, the safety and clinical outcomes for a completely protocolized minimalist approach utilizing computed tomography angiogram (CTA), intracardiac echocardiography (ICE), conscious sedation, and same-day discharge are lacking. We retrospectively studied 179 patients undergoing LAAO for nonvalvular atrial fibrillation using a novel "Minimalist" pathway. Efficacy and safety endpoints included stroke, systemic embolism, major bleeding requiring transfusion, pericardial effusion, vascular complication, or death through 7 or 45 days post-procedure. The procedural success rate in Minimalist cases was 100%. A total of 159 patients (88.8%) were eligible for SDD. All patients survived to 45 days of follow up and there was a 0% incidence of stroke, systemic embolism, and vascular complications. There were low rates of DRT (1.3%) and peri-device flow (0.7%), yielding a high rate of safe OAC discontinuation. Using a pre-defined Minimalist pathway, eligible patients demonstrated excellent clinical outcomes comparable to those reported in national clinical registries, supporting use of our novel pathway to safely improve both patient experience and efficiency of care.