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

BACKGROUND: The safety and cost of concomitant atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) procedure remain unknown. OBJECTIVE: The study sought to determine real-world outcomes of AF patients who underwent LAAO with ablation. METHODS: 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. RESULTS: 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). CONCLUSION: 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.