A Retrospective Look at Patient, Procedural, and Follow-up Characteristics Associated With WATCHMAN Implantation

Abstract

Background: Persons with atrial fibrillation (AF) are at risk for stroke. Atrial fibrillation-related strokes most often result for emboli arising from the left atrial appendage (LAA). Stroke prevention includes the use of anticoagulants and/or antiplatelets. These medications can result in bleeding complications. An alternative to anticoagulants is the WATCHMAN device, which is delivered in the left atria resulting in closure of LAA.

Objective: The aim of this study was to describe patient, procedural, and follow-up characteristics in patients who have undergone WATCHMAN implantation.

Methods: This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database.

Results: During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at 45 days indicated that the LAA seal showed no leak or flow around the device or a leak less than 5 mm. At 1 year, 95% (n = 36) of patients were only taking a single antiplatelet drug with aspirin. Eight patients were on a single antiplatelet medication at the time of follow-up 2 years after the procedure.

Discussion: A skilled team including a designated AF clinical nurse specialist contributed to program success measured by efficient placement of the WATCHMAN device and discontinuation of anticoagulation.