Left Atrial Appendage Closure With the Watchman^TM Device

Background:

Stroke secondary to atrial fibrillation has been associated to a high risk of permanent, severe disability, and high early mortality, and therefore its effective prevention is of paramount importance. Warfarin therapy reduces the risk of stroke by 60%, however, half of the patients with atrial fibrillation do not receive anticoagulation. Left atrial appendage closure has emerged as an alternative strategy for stroke prevention.

Methods:

Patients with atrial fibrillation and CHADSVASc score ≥ 2, not eligible for anticoagulation, were submitted to left atrial appendage closure using the Watchman^TM device. The procedure was performed under general anesthesia and was guided by transesophageal echocardiography.

Results:

Of the 11 selected patients, 2 were not treated due to thrombi presented prior or during the procedure and before device implantation. Mean age was 74 ± 5.1 years, 66% were male, CHA2DS2-VASc score was 4 ± 1.4, HASBLED score was 3.4 ± 1.1, 77% had contraindications or had unfavorable social conditions for anticoagulation. Technical success was 100% and complete occlusion was obtained in all of the cases, with a mean fluoroscopic time of 22.1 ± 10.8 minutes, and no hospital complications. At a follow-up of 78.3 ± 41.5 days, there were no clinical events but one patient had thrombus formation on the device and received anticoagulation for 3 months.

Conclusions:

Left atrial appendage closure with the Watchman^TM device is feasible and may be a good alternative therapy for stroke prevention in patients with atrial fibrillation and restrictions for anticoagulation.

Atrial fibrillation; Atrial appendage; Stroke