Introduction

Atrial fibrillation (AF) affects an estimated 33.5 million patients worldwide, including 5 million patients in the United States alone1. AF is associated with increased stroke risk, particularly among the elderly2. In cases of stroke in which a thrombus can be identified, the left atrial appendage (LAA) is implicated in more than 90% of cases3. Left atrial appendage closure (LAAC) devices have emerged as a novel alternative option to minimize embolic stroke burden among patients with non-valvular AF as an alternative to indefinite oral anticoagulation. The WATCHMAN (Boston Scientific, Natick, MA) device is the first FDA approved percutaneous approach for LAAC 4. Approval was granted on the basis of results from two randomized controlled trials, PROTECT-AF5 and PREVAIL6. However, initially, high rates of serious procedural and device-related events were noted, including pericardial effusion, cardiac tamponade, device-related thrombus, device-related embolism, and stroke5–7. Recent data suggests that these event rates have steadily declined since FDA approval8. Other percutaneous LAAC devices include the AMPLATZER cardiac plug, the AMPLATZER Amulet device (St. Jude Medical; Saint Paul, MN) and the WaveCrest device (Coherex Medical; Salt Lake City, UT) which are available in Europe. The LARIAT Suture Delivery Device (SentreHEART, Inc; Redwood City, CA) offers an epicardial approach with a success rate of 95%, but concerns remain about device safety9,10. With the advent of new diagnostic tools, such as mobile telemetry11, detection of AF and the volume of LAAC procedures will likely increase.
Since Watchman’s FDA approval in March 2015 its use has gained popularity nationwide, however, data regarding readmission rates after device insertion in the post-market era are largely unknown. The Centers of Medicare and Medicaid Services (CMS) increasingly utilizes 30-day readmission rates as a metric of hospital performance. Therefore, we sought to determine the incidence, predictors, and causes of readmissions following LAAC device insertion.
Additionally, we also set out to develop and validate a scoring system to predict 30-day readmission after LAAC device insertion.