Left Atrial Appendage Closure With the Watchman™ Device

Abstract

ABSTRACT 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.