Outcomes of left atrial appendage occlusion with atrial fibrillation ablation: a real-world analysis from the National Inpatient Sample database

TL;DR

Combining left atrial appendage occlusion with atrial fibrillation ablation increases complications and costs compared to the procedure alone.

Contribution

This study provides real-world evidence on the risks and costs of combining two cardiac procedures.

Findings

Combined procedures had higher complication rates and longer hospital stays.

Hospitalization costs were significantly higher for combined procedures.

More patients needed pacemakers and experienced kidney injury with the combined approach.

Abstract

The safety and cost of concomitant atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) procedure remain unknown.

The study sought to determine real-world outcomes of AF patients who underwent LAAO with ablation.

The National Inpatient Sample and International Classification of Diseases–Tenth Revision codes were used to identify patients who underwent LAAO with and without AF ablation during the years 2016–2022. The outcomes assessed included procedural complications and resource utilization.

LAAO with AF ablation was associated with a higher rate of overall (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.37–1.74), major complications (OR 1.38, 95% CI 1.18–1.60), non-home discharge (OR 1.55, 95% CI 1.23–1.96), prolonged length of stay > 1 day (OR 3.21, 95% CI 2.92–3.52), and increased hospitalization costs as defined by median cost > $25,926 (OR 19.42, 95% CI 16.21–23.25) when compared to LAAO alone after adjustment for potential confounding variables. Patients who underwent LAAO with ablation were also more likely to receive pacemaker implantation (3.6% vs 0.2%, P < 0.001) and experience acute kidney injury (3.9% vs 2.1%, P < 0.001) and non-ST elevation myocardial infarction (3.7% vs 1.5%, P < 0.001).

In a large, contemporary, real-world study of LAAO procedures in the USA, concomitant AF ablation was associated with a higher rate of overall and major complications and an increased resource utilization.

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