Physician Perceptions Vary Regarding Left Atrial Appendage Occlusion for AF

Procedural risks and complications were the biggest reasons for not recommending left atrial appendage occlusion (LAAO), and history of intracranial bleeding was cited as the most popular reason for LAAO recommendation.

A majority of physicians consider “procedural risks and complications” as the primary reason to limit their recommendations for percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Researchers evaluated the perceptions and approaches of physicians who are typically involved in the decision-making process of LAAO. They randomly identified 500 physicians for each of the following specialty areas: general cardiologists, interventional cardiologists, electrophysiologists, and vascular neurologists.

Surveys were mailed to participants as many as 3 times between November 9, 2021, and January 14, 2022. The survey included 28 questions regarding experiences, perceptions, approaches, and a patient vignette. The physicians were randomly assigned to 1 of 4 versions to assess potential disparities in decision-making: White man, White woman, Black man, and Black woman.

Among 122 responders, 59.8% considered “procedural risks and complications” as reasons to limit their recommendations for LAAO, and 42.6% considered “limiting efficacy data comparing LAAO to non-vitamin K oral anti-coagulants (NOACs)” as a reason to limit their recommendations. Nearly all responders (97.5%) considered evidence from randomized controlled trials (RCTs) as extremely or very useful, and 29.5% believed this for observational studies.

Future RCTs are needed to close the evidence gaps and establish consistent best practices for this important device therapy.

The 3 leading reasons for considering LAAO were a history of intracranial bleeding (94.3%), a history of major extracranial bleeding (91.8%), and gastrointestinal lesions (59.0%). The 3 main reasons for withholding LAAO were other indications for long-term oral anticoagulation (87.7%), low bleeding risk (77.0%), and low stroke risk (65.6%).

No difference in decision-making according to patients’ race (P =.73), sex (P =.12), or combination of race and sex (P =.30) was observed according to the patient vignette, which indicated no unconscious bias against women or minority groups. Of the responders who performed LAAO, 83.8% would consider NOACs after the device was implanted.

“In the first US national physician survey, we found considerable variations in perceptions and approaches related to the practice of LAAO,” the researchers conclude. “Future RCTs are needed to close the evidence gaps and establish consistent best practices for this important device therapy.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Yao X, Kir D, Van Houten H, et al. Physicians’ perspectives on percutaneous left atrial appendage occlusion for patients with atrial fibrillation. Abstract presented at: ACC 2023; March 4-6, 2023; New Orleans, LA. Abstract 1101-006.