Clinical Outcomes following Left Atrial Appendage Occlusion: A Single-Center Experience

Area of Science:

• Cardiology
• Medical Devices
• Interventional Cardiology

Background:

• Percutaneous left atrial appendage closure (LAAC) with the Watchman® device is an alternative to anticoagulation for stroke prevention in nonvalvular atrial fibrillation (NVAF).
• Current guidelines lack clarity on optimal antithrombotic therapy, anticoagulation cessation timing, and follow-up imaging post-Watchman® device deployment.
• Evaluating clinical outcomes after LAAC is crucial for refining patient management strategies.

Purpose of the Study:

• To assess clinical outcomes in patients who underwent Watchman® device implantation for NVAF.
• To investigate the impact of antithrombotic strategies on bleeding events.
• To determine the association between device size and thromboembolic risk, and to evaluate the natural history of peridevice leak (PDL).

Main Methods:

• Retrospective review of 231 patients who received a Watchman® device between January 2010 and December 2018.
• Cox-proportional hazard models were used to analyze the effect of variables on clinical outcomes.
• Analysis included bleeding events, thromboembolic events, and peridevice leak (PDL) progression.

Main Results:

• No significant difference in bleeding risk was observed based on the initial antithrombotic choice.
• Patients with a history of gastrointestinal bleeding had a higher risk of bleeding within 6 weeks post-implantation (HR 9.40).
• Smaller Watchman® device sizes (21 mm) were associated with an increased risk of thromboembolic events compared to larger sizes (24-27 mm) (HR 0.15).
• Peridevice leak (PDL) size generally remained stable or increased on follow-up imaging.

Conclusions:

• Initial antithrombotic choice does not significantly impact bleeding risk following Watchman® implantation.
• Smaller device sizes are linked to higher rates of thromboembolic events.
• Longitudinal assessment of PDL indicates that these leaks often do not resolve spontaneously.
• Larger prospective studies are warranted to confirm these findings and inform clinical practice.