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Updated: Oct 13, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Atrial appendage closure in patients with heart failure and atrial fibrillation: industry-independent single-centre
Mohammed Saad1,2, Mohamed Osman2,3,4, Hosam Hasan-Ali4
1Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, Kiel, 24105, Germany.
Insights
Percutaneous left atrial appendage closure (LAAC) is safe for patients with congestive heart failure (CHF) and atrial fibrillation (AF). However, CHF patients face higher long-term mortality risks due to associated comorbidities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Non-valvular atrial fibrillation (AF) increases stroke risk.
- Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention.
- Congestive heart failure (CHF) is a common comorbidity in AF patients, potentially impacting procedural outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous LAAC in patients with non-valvular AF and CHF.
- To compare periprocedural success and long-term complications between patients with and without CHF undergoing LAAC.
- To identify predictors of adverse events in this patient population.
Main Methods:
- A consecutive, industry-independent registry of patients undergoing transcatheter LAAC from January 2014 to December 2019.
- Comparison of patients with CHF (defined by LVEF or RV function) versus patients without CHF.
- Assessment of periprocedural complications and long-term major adverse cardiac and cerebrovascular events (MACCE), including mortality.
Main Results:
- A total of 300 patients underwent LAAC; 96 with CHF and 204 without.
- Lower implantation success was observed in the CHF group (96%) compared to the non-CHF group (99.5%, P=0.038).
- Patients with CHF had significantly higher rates of MACCE (31.9% vs. 15.1%, P=0.002) and mortality (24.2% vs. 7%, P≤0.001) during long-term follow-up.
Conclusions:
- Percutaneous LAAC is a safe procedure for patients with non-valvular AF and CHF.
- CHF is an independent predictor of long-term mortality following LAAC.
- Increased mortality in CHF patients is likely driven by underlying comorbidities rather than the LAAC procedure itself.
Aims:
To evaluate outcomes of percutaneous left atrial appendage closure (LAAC) in patients with congestive heart failure (CHF) and non-valvular atrial fibrillation (AF) in a consecutive, industry-independent registry associated with periprocedural success and complications during long-term follow-up.
Methods And Results:
For this analysis, we included patients who underwent transcatheter LAAC from January 2014 to December 2019 at the University Heart Center in Lübeck, Germany, and compared patients with presence of CHF defined as patients with a reduced left ventricular ejection fraction (LVEF ≤ 40%), patients with a mid-range LVEF (LVEF 41-49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right-sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion < 17) to patients undergoing LAAC with no CHF. Primary endpoints were defined as periprocedural complications, and complications during long-term follow-up presented as major adverse cardiac and cerebrovascular events (MACCE). A total of 300 consecutive patients underwent LAAC. Of these, 96 patients in the CHF group were compared with 204 patients in the non-CHF group. Implantation success was lower in CHF group in comparison with non-CHF group (99.5% vs. 96%, P = 0.038); otherwise, there were no differences in periprocedural complications between groups. Patients with CHF showed a significantly higher incidence of MACCE rate (31.9% vs. 15.1%, P = 0.002) and more deaths (24.2% vs. 7%, P ≤ 0.001) during long-term follow-up. In Cox multivariable regression analysis, CHF was an independent predictor of mortality after LAAC implantation at long-term follow-up (hazard ratio 3.23, 95% confidence intervals 1.52-6.86, P = 0.002).
Conclusions:
Implantation of LAAC devices in patients with non-valvular AF and CHF is safe. The increased mortality in patients with CHF compared with patients without CHF during the long-term follow-up is mainly attributed to comorbidities associated with CHF.
