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open access

Vol 28, No 4 (2021)
Original Article
Submitted: 2020-11-08
Accepted: 2020-12-03
Published online: 2020-12-31
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Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure

Caroline Kleinecke1, Wasim Allakkis2, Eric Buffle3, Xiao-Xia Liu24, Yamen Mohrez2, Steffen Gloekler3, Johannes Brachmann2, Steffen Schnupp2, Stephan Achenbach5, Jiangtao Yu16
DOI: 10.5603/CJ.a2020.0184
·
Pubmed: 33438184
·
Cardiol J 2021;28(4):519-527.
Affiliations
  1. Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
  2. Department of Cardiology, REGIOMED Klinikum Coburg, Coburg, Germany
  3. Department of Cardiology, University Hospital Bern, Bern, Switzerland
  4. Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
  5. Department of Cardiology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany
  6. Department of Cardiology, Klinikum Koblenz-Montabaur, Koblenz, Germany

open access

Vol 28, No 4 (2021)
Original articles — Interventional cardiology
Submitted: 2020-11-08
Accepted: 2020-12-03
Published online: 2020-12-31

Abstract

Background: Transcatheter left atrial appendage closure (LAAC) is performed either in conscious sedation (CS) or general anesthesia (GA), and limited data exist regarding clinical outcomes for the two approaches. The aim of the study was to analyze the effect of CS versus GA on acute outcomes in a large patient cohort undergoing LAAC with a Watchman occluder.
Methods: A cohort of 521 consecutive patients underwent LAAC with Watchman occluders at two centers (REGIOMED hospitals, Germany) between 2012 and 2018. One site performed 303 consecutive LAAC procedures in GA, and the other site performed 218 consecutive procedures in CS. The safety endpoint was a composite of major periprocedural complications and postoperative pneumonia. The efficacy endpoint was defined as device success.
Results: After a 1:1 propensity score matching, 196 (CS) vs. 115 (GA) patients could be compared. In 5 (2.6%) cases CS was converted to GA. The primary safety endpoint (3.5% [CS] vs. 7.0% [GA], p = 0.18) and its components (major periprocedural complications: 2.5% vs. 3.5%, p = 0.73; postoperative pneumonia: 2.6% vs. 4.3%, p = 0.51) did not differ between the groups. Also, device success was comparable (96.9% vs. 93.9%, p = 0.24).
Conclusions: In patients undergoing LAAC with the Watchman device, conscious sedation and general anesthesia showed comparable device success rates and safety outcomes. The type of anesthesia for LAAC may therefore be tailored to patient comorbidities, operator experience, and hospital logistics.

Abstract

Background: Transcatheter left atrial appendage closure (LAAC) is performed either in conscious sedation (CS) or general anesthesia (GA), and limited data exist regarding clinical outcomes for the two approaches. The aim of the study was to analyze the effect of CS versus GA on acute outcomes in a large patient cohort undergoing LAAC with a Watchman occluder.
Methods: A cohort of 521 consecutive patients underwent LAAC with Watchman occluders at two centers (REGIOMED hospitals, Germany) between 2012 and 2018. One site performed 303 consecutive LAAC procedures in GA, and the other site performed 218 consecutive procedures in CS. The safety endpoint was a composite of major periprocedural complications and postoperative pneumonia. The efficacy endpoint was defined as device success.
Results: After a 1:1 propensity score matching, 196 (CS) vs. 115 (GA) patients could be compared. In 5 (2.6%) cases CS was converted to GA. The primary safety endpoint (3.5% [CS] vs. 7.0% [GA], p = 0.18) and its components (major periprocedural complications: 2.5% vs. 3.5%, p = 0.73; postoperative pneumonia: 2.6% vs. 4.3%, p = 0.51) did not differ between the groups. Also, device success was comparable (96.9% vs. 93.9%, p = 0.24).
Conclusions: In patients undergoing LAAC with the Watchman device, conscious sedation and general anesthesia showed comparable device success rates and safety outcomes. The type of anesthesia for LAAC may therefore be tailored to patient comorbidities, operator experience, and hospital logistics.

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Keywords

atrial fibrillation, left atrial appendage closure, conscious sedation, general anesthesia, Watchman

About this article
Title

Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure

Journal

Cardiology Journal

Issue

Vol 28, No 4 (2021)

Article type

Original Article

Pages

519-527

Published online

2020-12-31

Page views

1090

Article views/downloads

1269

DOI

10.5603/CJ.a2020.0184

Pubmed

33438184

Bibliographic record

Cardiol J 2021;28(4):519-527.

Keywords

atrial fibrillation
left atrial appendage closure
conscious sedation
general anesthesia
Watchman

Authors

Caroline Kleinecke
Wasim Allakkis
Eric Buffle
Xiao-Xia Liu
Yamen Mohrez
Steffen Gloekler
Johannes Brachmann
Steffen Schnupp
Stephan Achenbach
Jiangtao Yu

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