{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:36:57Z","timestamp":1787841417637,"version":"build-2784847793"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Context:<\/jats:title>\n Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.<\/jats:p>\n <\/jats:sec>\n \n Aims:<\/jats:title>\n Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.<\/jats:p>\n <\/jats:sec>\n \n Settings and Design:<\/jats:title>\n Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.<\/jats:p>\n <\/jats:sec>\n \n Material and Methods:<\/jats:title>\n Retrospective data analysis from 2017\u20132021.<\/jats:p>\n <\/jats:sec>\n \n Statistical Analysis Used:<\/jats:title>\n Independent-sample t tests or Mann\u2013Whitney U tests were used for continuous variables and Chi-square tests or Fisher\u2019s exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017\u20132021 (\n P<\/jats:italic>\n < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of\u2265 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all\n P<\/jats:italic>\n < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03\u20130.80,\n P<\/jats:italic>\n = 0.0261).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017\u20132021. Anesthetic management for LAAC varies with geographic location.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aca.aca_14_24","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T11:03:32Z","timestamp":1720091012000},"page":"220-227","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis"],"prefix":"10.4103","volume":"27","author":[{"given":"William","family":"Hickman","sequence":"first","affiliation":[{"name":"School of Medicine, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"Dada","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Thibault","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikrant","family":"Jagadeesan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather K.","family":"Hayanga","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"R1-20240901","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","article-title":"Epidemiology of atrial fibrillation in the 21st century","volume":"127","author":"Kornej","year":"2020","journal-title":"Circ Res"},{"key":"R2-20240901","doi-asserted-by":"crossref","first-page":"92","DOI":"10.4103\/jfcm.JFCM_99_18","article-title":"Stroke in atrial fibrillation: Review of risk stratification and preventive therapy","volume":"26","author":"Alshehri","year":"2019","journal-title":"J Family Community Med"},{"key":"R3-20240901","doi-asserted-by":"crossref","first-page":"3442","DOI":"10.1161\/STR.0b013e318266722a","article-title":"Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: A science advisory for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"43","author":"Furie","year":"2012","journal-title":"Stroke"},{"key":"R4-20240901","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1001\/jama.285.22.2864","article-title":"Validation of clinical classification schemes for predicting stroke","volume":"285","author":"Gage","year":"2001","journal-title":"JAMA"},{"key":"R5-20240901","doi-asserted-by":"crossref","first-page":"2N","DOI":"10.1016\/S0002-9149(98)00583-9","article-title":"Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates 11Reprints are not available","volume":"82","author":"Kannel","year":"1998","journal-title":"Am J Cardiol"},{"key":"R6-20240901","doi-asserted-by":"crossref","first-page":"857","DOI":"10.7326\/0003-4819-146-12-200706190-00007","article-title":"Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation","volume":"146","author":"Hart","year":"2007","journal-title":"Ann Intern Med"},{"key":"R7-20240901","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.017559","article-title":"Warden B. 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