Key result
Left atrial appendage closure under moderate conscious sedation was safe and feasible, with 0% complications and no conversions to general anesthesia required among 112 patients.
Why the study?
LAAC procedures in the United States are currently performed under general anesthesia, and the feasibility, effectiveness, and safety of performing LAAC under moderate conscious sedation needed evaluation.
Is left atrial appendage closure under moderate conscious sedation safe and effective in patients with atrial fibrillation?
Observational (n=112)
Is left atrial appendage closure under moderate conscious sedation safe and effective in patients with atrial fibrillation?
Left atrial appendage closure can be safely and effectively performed under moderate conscious sedation, potentially simplifying the procedure and reducing costs compared to general anesthesia.
May support moderate sedation for LAA closure; leaves open randomized confirmation before practice change.
BACKGROUND: Left atrial appendage closure (LAAC) using the Watchman device has become a well-established, world-wide therapeutic alternative to oral anticoagulation in high-risk patients for bleeding with paroxysmal, persistent atrial fibrillation (Afib) or permanent Afib. Currently, in the United States, LAAC procedures are performed under general anesthesia (GA). We present the feasibility, effectiveness, and safety of LAAC under moderate conscious sedation (MCS). METHODS: A total of 112 patients with elevated CHA2DS22VASc (median score of 3) between November 2018 and November 2019 underwent transesophageal echocardiography (TEE)-guided LAAC with the FDA-approved Watchman LAAC device (Boston Scientific) under MCS. We prospectively evaluated clinical and procedural outcomes using medical records of these patients. RESULTS: Mean patient age was 73.5 ± 4.5 years and 45 (40%) were women. Procedural duration, device implant time, and fluoroscopic times were 45 ± 8.6 minutes, 14.5 ± 2.8 minutes, and 10.2 ± 1.2 minutes, respectively. The median required dosage of propofol was 101 ± 2.8 mg. No complications were observed from MCS. There was no need for conversion to GA in any of the patients during the procedure. CONCLUSIONS: LAAC is safe and effective when performed under MCS. Thus, applying MCS may simplify the LAAC procedure, as well as reduce procedural time and procedural costs, while increasing overall patient satisfaction.
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Ateş et al. (2020) conducted an observational in Atrial fibrillation (n=112). Moderate conscious sedation was evaluated on Complications from moderate conscious sedation. Left atrial appendage closure under moderate conscious sedation was safe and feasible, with 0% complications and no conversions to general anesthesia required among 112 patients.
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