Association of Physician Certification and Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion.

BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) is indicated in patients with atrial fibrillation for whom long-term oral anticoagulation is contraindicated. Whether outcomes are different based on operator certification (interventional cardiology [IC] vs electrophysiology [EP]) is unclear. OBJECTIVES: The authors sought to compare LAAO outcomes by physician certification (EP vs IC) in the NCDR (National Cardiovascular Data Registry) LAAO Registry. METHODS: We identified patients from 2020 to 2022 undergoing implantation of a Watchman FLX (Boston Scientific) or Amulet (Abbott Cardiovascular) LAAO device and stratified patients by primary operator certification. Outcomes of interest included: 1) any major adverse event (MAE); 2) mortality; 3) ischemic stroke; and 4) major bleeding during the initial hospitalization and at 45 days. We performed multivariable Cox proportional hazards regression analysis to determine the risk of adverse events by physician certification. RESULTS: A total of 1,638 physicians (57% electrophysiologists) performing 91,711 procedures during the study period were included. EPs were more likely to use intracardiac echocardiography (25.2% vs 9.7%; P < 0.001) and had lower radiation total (235 mGy vs 305 mGy; P < 0.001). EPs were more likely than ICs to discharge patients on DOAC + aspirin, whereas ICs were more likely to discharge patients on single or dual antiplatelet therapy (all P < 0.001). In-hospital death (0.1% vs 0.1%; P = 0.46) and MAE (1.5% vs 1.6%; P = 0.42) were similar by physician certification. At 45 days, there was no difference in death (HRdeath: 1.03; 95% CI: 0.89-1.20) or MAE (HRMAE: 0.97; 95% CI: 0.91-1.03) after multivariable regression. CONCLUSIONS: Contemporary LAAO is safe with low rates of procedural complications and no significant differences in procedural outcomes by operator subspecialty after multivariable adjustment. Continued utilization of technology by EPs and ICs is necessary to allow for broad access to this treatment for eligible patients.

Duke Scholars

Author Daniel Friedman Medicine, Cardiology