Percutaneous left atrial appendage closure for thromboembolic prophylaxis in patients with atrial fibrillation. The impact of operator’s experience on the procedure course

Background. Left atrial appendage (LAA) closure represents an alternative strategy to oral anticoagulants in thromboembolic prophylaxis in patients with atrial fibrillation (AF). The LAA closure with the WATCHMAN™ device has been proved to be non-inferior to warfarin therapy. Nevertheless, this strategy is associated with numerous periprocedural complications. This study was conducted to determine whether the experience of the operating team affects the duration of the procedure and its complication rate. Methods. This retrospective single-centre study examined LAA percutaneous closure procedures in 43 consecutive AF patients with contraindications to oral anticoagulation (13 female, 30 male; mean age 70.98 ± 10.69 years). All device implantations were performed by two operators using the WATCHMAN™ device and the result was assessed by two echocardiographers. We compared the first 22 (group A) with the subsequent 21 procedures (group B). Results. For group B, a decrease in the overall procedure time (PT) by 28% (from 83.41 min ± 36.49 to 59.76 min ± 21.70; p = 0.006) was found, with a subsequent reduction in fluoroscopy time (FT) by 33% (from 16.59 min ± 7.25 to 11.2 min ± 7.21; p = 0.019) and the volume of contrast medium (CV) by 40% (from 129.14 mL ± 79.81 to 78.05 mL ± 33.82; p = 0.004). The incidence of periprocedural adverse events and complications was 55% (12 patients) in group A and 33% (7 patients) in group B. Conclusions. The increasing operators’ and echocardiographers’ experience in LAA closure is associated with reduction in procedure time, fluoroscopy time and contrast volume.