Abstract:
BACKGROUND:Little is known about the role of left atrial appendage closure using the Watchman device (Boston Scientific) in patients who are at very high risk for stroke. OBJECTIVE:The purpose of this study was to assess the role of Watchman in patients with CHA2DS2-VASc ≥5. METHODS:All patients undergoing procedures for Watchman implant at our institution were enrolled in a prospective registry. All 104 consecutive recipients with CHA2DS2-VASc ≥5 were included. RESULTS:Median patient age was 78.5 ± 6.4 years, 56% were male, mean CHA2DS2-VASc was 5.7 ± 0.9, and mean HASBLED was 4.0 ± 1.0. Indications for implantation were significant prior bleeding (73%), unacceptable bleeding risk (21%), and unacceptable stroke and bleeding risk (6%). Watchman implantation was successful in all patients. All but 2 patients completed 45 days of postprocedural anticoagulation; 56% used warfarin and 44% used a novel oral anticoagulant. Transesophageal echocardiogram at 45 days revealed no significant peridevice leak. One patient was found to have a small mobile, filamentous echodensity attached on the medial aspect of the Watchman device. This resolved with longer anticoagulation with dabigatran and did not result in adverse outcome. At 1-year follow up, ischemic stroke had occurred in 3 patients (2.8%) at 96, 119, and 276 days after the procedure. CONCLUSION:In a population of patients with mean CHA2DS2-VASc of 5.7, Watchman implantation seemed to be safe and efficacious, with a residual annual ischemic stroke risk of 2.8%. In an atrial fibrillation population with a similar CHA2DS2-VASc score, the estimated annual risk of stroke is ≈12% off anticoagulation and >4% on warfarin.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Hutt E,Wazni OM,Kaur S,Saliba WI,Tarakji KG,Kapadia S,Aguilera J,Barakat AF,Abdallah M,Jaber W,Rasmussen P,Hussain S,Uchino K,Wisco D,Lindsay BD,Kanj M,Hussein AAdoi
10.1016/j.hrthm.2019.07.011subject
Has Abstractpub_date
2020-01-01 00:00:00pages
27-32issue
1eissn
1547-5271issn
1556-3871pii
S1547-5271(19)30643-5journal_volume
17pub_type
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