Outcomes of same-day discharge after left atrial appendage closure with and without pre-discharge transthoracic echocardiography

Abstract

Background: Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo left atrial appendage closure. SCAI/HRS consensus recommends routine post-procedure transthoracic echocardiography (TTE) before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.

Methods: We performed a retrospective observational study using the data from our institutional LAAC registry. We compared patients discharged on the same day after the procedure who underwent a TTE vs patients who were discharged without a TTE. The primary outcome studied was 45-day readmission for any given reason from the day of discharge.

Results: In a cohort of patients who were discharged on the same day, 350 did not undergo post-procedure TTE, and 60 underwent TTE. 33 patients were readmitted in the TTE group, and 4 patients were readmitted in the No TTE group. The RR for readmission without vs. with pre-discharge TTE was 1.41 (95 % CI 0.52-3.85, p = 0.25). No 45-day mortality occurred in either study group.

Conclusion: For patients undergoing LAAC with same-day discharge, routine TTE before discharge did not significantly influence 45-day readmission rates. Given the absence of clinical benefit but the presence of TTE costs and resource use, a more selective approach to post-procedural imaging should be considered.