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Updated: May 6, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation
Ulf Landmesser1, David R Holmes
1Cardiology, Cardiovascular Center, University Hospital Zurich, Raemistrassse 100, 8091 Zurich, Switzerland. ulf.landmesser@usz.ch
Insights
Left atrial appendage occlusion offers a stroke prevention alternative for atrial fibrillation patients who cannot take anticoagulants. Studies show LAA closure with devices like Watchman can be as effective as warfarin, with careful procedures minimizing risks.
Area of Science:
- Cardiology
- Medical Devices
- Stroke Prevention
Background:
- Atrial fibrillation (AF) is a major stroke risk factor, particularly in the elderly.
- Warfarin anticoagulation reduces stroke risk by ~60% but has contraindications and suboptimal adherence.
- Novel anticoagulants improve compliance and reduce bleeding but still carry risks over time.
Purpose of the Study:
- To evaluate transcatheter left atrial appendage (LAA) closure as a novel stroke prevention strategy in non-valvular AF patients.
- To compare the efficacy and safety of LAA occlusion devices with warfarin therapy.
Main Methods:
- Transcatheter LAA occlusion using devices like Watchman and Amplatzer Cardiac Plug (ACP).
- The PROTECT-AF trial: a randomized clinical trial comparing Watchman LAA occlusion to warfarin.
- The PREVAIL and ACP trials are further evaluating LAA occlusion systems.
Main Results:
- PROTECT-AF demonstrated LAA occlusion with Watchman was non-inferior to warfarin for a combined endpoint in patients with non-valvular AF.
- Successful LAA occlusion was achieved in 86% of patients meeting TEE criteria.
- Periprocedural complications like pericardial effusion and stroke can occur but are minimized with operator experience and device improvements.
Conclusions:
- Transcatheter LAA occlusion is a viable alternative stroke prevention strategy for AF patients, especially those with contraindications to anticoagulation.
- Continued research and operator training are crucial for optimizing safety and efficacy of LAA occlusion procedures.
Abstract:
Atrial fibrillation is a frequent cause of stroke; in the elderly, more than 20% of strokes are attributed to this common arrhythmia. Anticoagulation with warfarin reduces the risk of stroke by ∼60%; however, a large proportion of patients with atrial fibrillation do not receive this treatment because of relative/absolute contraindications. Moreover, patients often discontinue warfarin for a variety of reasons and chronic warfarin administration rates remain suboptimal. Although the compliance with anticoagulation may improve with novel anticoagulants and bleeding risk can be somewhat reduced when compared with warfarin, there is still a progressive increase in bleeding complications over time. Accordingly, new approaches for stroke prevention in these patients are being explored and tested. In transoesophageal echocardiographic (TEE) studies, more than 90% of thrombi were found in the left atrial appendage (LAA) in non-valvular atrial fibrillation, and transcatheter LAA closure is developed and examined as a novel approach to reduce the risk of stroke in these patients. The PROTECT-AF study provides first evidence from a randomized clinical trial that a strategy of LAA occlusion using the Watchman device can be non-inferior to anticoagulation with warfarin for a combined endpoint in patients with non-valvular atrial fibrillation (mean CHADS(2) score 1.8). In successfully occluded patients fulfilling TEE criteria (86%), warfarin was stopped after 45 days, followed by aspirin and clopidogrel for 6 months after randomization and subsequently aspirin. The PREVAIL trial is further evaluating this concept. Limited data are available for another LAA occlusion system, the Amplatzer Cardiac Plug (ACP) device, for which the ACP trial has been initiated. Left atrial appendage occlusion needs to be performed with meticulous care by experienced operators because periprocedural complications such as pericardial effusion or stroke have been documented. With increased operator experience and technical improvements of the device, these complications can be minimized.
