Arrhythmias & electrophysiology
Impact of Operator Experience on Left Atrial Appendage Occlusion Outcomes
Authors' conclusion
Performing ≥32 LAAOs annually could be a threshold to categorize an experienced operator. Before reaching this threshold, the risk of death, stroke, systemic embolism, and BARC-defined type 3 or 5 bleeding decreased by 12% after every 5 cases performed.
Study context
- Population
- Patients undergoing left atrial appendage occlusion (LAAO) alone with the WATCHMAN device in China, April 2019–October 2020 (concomitant ablation/other procedures excluded)111 operators
- Participants
- 1,547 patients
- Comparison
- Operator volume <32 vs ≥32 LAAOs annually
- Primary endpoint
- Composite of:
- Death
- Stroke
- Systemic embolism and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding
- Follow-up
- 1 year
Methodological detailsmulticentre
- Multicentre
Primary result
As reported in the abstract
<32 vs ≥32Estimate (95% CI)P value
Adjusted
HR 1.79(1.16–2.78)
P = 0.009Adjusted; within <32
HR per 5 additional cases 0.88(0.78–0.99)
P = 0.033Further findings
Experienced-operator threshold (maximally selected log-rank statistics)
- ≥32 annually better criterion than ≥134 in total (absolute net reclassification index)
- 25.79%; P < 0.001
- Thresholds: ≥32 LAAOs annually or ≥134 LAAOs in total
Original publication
Impact of Operator Experience on Left Atrial Appendage Occlusion Outcomes. JACC Clin Electrophysiol. Published 11 September 2024. doi:10.
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