Multicenter Experience of Percutaneous Left Atrial Appendage Occlusion in Current Indications and Different Anesthetic Approaches.

Abstract

Background: Stroke remains a concern in patients with atrial fibrillation despite the efficacy of oral anticoagulants. Left atrial appendage closure has emerged as a treatment option for patients with suboptimal pharmacological therapy.

Objectives: This retrospective multicenter study aimed to evaluate the feasibility, safety, and outcomes of left atrial appendage occlusion procedures for two different indications. Short-term outcomes between two different methods of general anesthesia during the procedures were also compared.

Methods: The study included patients who underwent appendage closure between September 2017 and June 2021. Two indications for the procedures, anticoagulant intolerance, and anticoagulant inadequacy were recorded. One-year outcomes were analyzed between groups. Short-term outcomes were compared between the intravenous general anesthesia with high-flow nasal cannula oxygen therapy and intubated general anesthesia groups.

Results: A total of 75 consecutive patients were enrolled: 19 patients in the anticoagulant inadequacy group and 56 in the anticoagulant intolerance group. Appendage occlusion was effective in reducing stroke risk in atrial fibrillation patients with suboptimal pharmacological therapy. There were no significant differences in outcomes between the two indication groups. Appendage closure under high-flow nasal cannula oxygen therapy was found to be feasible and safe, with comparable results to intubated general anesthesia.

Conclusions: Appendage occlusion is effective and safe for Taiwan National Health Insurance-approved indications, with no difference between indication groups during 1-year of follow-up. Appendage occlusion under high-flow nasal cannula oxygen therapy is feasible and comparable to intubated general anesthesia. Larger randomized studies with longer follow-up are needed to confirm these findings.