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Updated: Dec 15, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Meta-Analysis Comparing WatchmanTM and Amplatzer Devices for Stroke Prevention in Atrial Fibrillation
Indranill Basu Ray1,2,3, Dibbendhu Khanra3, Sumit Shah4
1Memphis VA Hospital, Memphis, TN, United States.
Insights
Left atrial appendage (LAA) closure devices, Amplatzer and Watchman, show similar safety and efficacy for preventing thromboembolic events in atrial fibrillation patients. Watchman had lower bleeding rates but higher insignificant peridevice leakages.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left atrial appendage (LAA) closure is an alternative for atrial fibrillation patients at high risk for bleeding or unable to use oral anticoagulation.
- This study compares the efficacy and safety of Amplatzer and Watchman LAA closure devices.
Approach:
- A meta-analysis of six studies involving 614 patients was conducted.
- Study quality was assessed using the Newcastle-Ottawa Scale.
- Safety and efficacy outcomes were compared between the Amplatzer and Watchman devices.
Key Points:
- Both LAA closure devices demonstrated low overall event rates.
- No significant differences were observed in safety outcomes (e.g., pericardial effusion, tamponade, embolization) or mortality/stroke rates.
- The Watchman group showed a significantly lower total bleeding rate but similar major/minor bleeding rates compared to Amplatzer.
- The Watchman group had significantly higher total and insignificant peridevice leakage rates, though significant leakages were comparable.
Conclusions:
- Amplatzer and Watchman LAA closure devices exhibit comparable efficacy and safety profiles.
- A key difference noted was a higher incidence of insignificant peridevice leakages with the Watchman device.
- Further insights are anticipated from an ongoing randomized controlled trial comparing these devices.
Abstract:
Background: For patients with atrial fibrillation who are at high risk for bleeding or who cannot tolerate oral anticoagulation, left atrial appendage (LAA) closure represents an alternative therapy for reducing risk for thromboembolic events. Objectives: To compare the efficacy and safety of the Amplatzer and WatchmanTM LAA closure devices. Methods: A meta-analysis was performed of studies comparing the safety and efficacy outcomes of the two devices. The Newcastle-Ottawa Scale was used to appraise study quality. Results: Six studies encompassing 614 patients were included in the meta-analysis. Overall event rates were low for both devices. No significant differences between the devices were found in safety outcomes (i.e., pericardial effusion, cardiac tamponade, device embolization, air embolism, and vascular complications) or in the rates of all-cause mortality, cardiac death, stroke/transient ischemic attack, or device-related thrombosis. The total bleeding rate was significantly lower in the WatchmanTM group (Log OR = -0.90; 95% CI = -1.76 to -0.04; p = 0.04), yet no significant differences was found when the bleeding rate was categorized into major and minor bleeding. Total peridevice leakage rate and insignificant peridevice leakage rate were significantly higher in the WatchmanTM group (Log OR = 1.32; 95% CI = 0.76 to 1.87; p < 0.01 and Log OR = 1.11; 95% CI = 0.50 to 1.72; p < 0.01, respectively). However, significant peridevice leakages were similar in both the devices. Conclusions: The LAA closure devices had low complication rates and low event rates. Efficacy and safety were similar between the systems, except for a higher percentage of insignificant peridevice leakages in the WatchmanTM group. A randomized controlled trial comparing both devices is underway, which may provide more insight on the safety and efficacy outcomes comparison of the devices.
