Abstract 4366729: Same-Day Discharge Following Left Atrial Appendage Closure: Periprocedural Safety and Follow-up Outcomes

Abstract

Introduction: Percutaneous left atrial appendage closure (LAAC) is an accepted non-pharmacological approach for stroke prevention in non-valvular AF in patients with contraindication to oral anticoagulation (OAC). This procedure is increasingly performed with minimalistic approach including same-day discharge (SDD). Our aim was to describe the safety and outcomes of SDD post-LAAC. Methods and Results: All patients undergoing LAAC at Vancouver General Hospital were enrolled in our prospective LAAC registry. Indications for LAAC were CHADS-VASc≥2 and unsuitability for OAC. Pre-procedural selection for SDD was based on physician and triage coordinator clinical judgements. Patients were assessed for overall physical conditioning, lack of significant frailty, lack of major co-morbidities limiting physical abilities, good home support, and patient preference. We assessed the peri-procedural and follow-up outcomes of SDD patients after LAAC. There were 163 patients with SDD from February 20, 2018 to April 16, 2025 post-LAAC. Their mean age was 74.5±6.4yrs, mean CHADS2-Vasc score was 3.9±1.5, mean HASBLED score was 2.9±1.1, 108 (66.3%) were men, 77 (47.2%) had permanent or persistent atrial fibrillation, 53 (32.5%) had prior strokes, 34 (14.7%) had prior transient ischemia attack, and 101 (62.0%) had chronic kidney disease. Procedural imaging was performed with TEE in 137 (84.0%) and intracardiac echocardiography in 27 (16.6%). In terms of indication for LAAC, 131 (80.4%) had any prior bleeding [of which 118 (72.4%) were categorized as major bleed and 111 (68.1%) were bleeding events on OAC], 18 (11.0%) had thromboembolism on OAC, and 5 (3.1%) had bleeding disorders. There was no procedural complication in this cohort; one patient had a small pericardial effusion on next-day transthoracic echocardiogram (TTE) that did not require intervention. Post-LAAC antithrombotic regimen included dual antiplatelet therapy in 148 (90.8%), OAC in 9 (5.5%), and single antiplatelet therapy in 6 (3.7%). Next-day TTE was performed in all patients. At mean follow-up of 1.5±0.9yrs, there were no clinical events, but one patient had asymptomatic device-related thrombus. Conclusion: Our results show that SDD is safe in select patients post-LAAC. SDD may enhance resource utilization, streamline hospital operations, and reduce healthcare costs without compromising patient safety.