Watchman device migration and embolization: A report from the NCDR LAAO Registry

Area of Science:

• Cardiology
• Medical Devices
• Interventional Cardiology

Background:

• Incomplete anchoring of the Watchman left atrial appendage closure (LAAO) device can lead to device migration or embolization (DME).
• DME necessitates percutaneous or surgical retrieval, posing significant risks to patients.

Purpose of the Study:

• To analyze the incidence, characteristics, and outcomes of Watchman device migration or embolization (DME).
• To identify risk factors associated with in-hospital and post-discharge DME events.

Main Methods:

• Retrospective analysis of Watchman procedures from the National Cardiovascular Data Registry LAAO Registry (January 2016–March 2021).
• Inclusion criteria: Watchman procedures excluding prior LAAO interventions, no device release, and missing device information.
• Assessment of in-hospital and post-discharge events (45-day follow-up) for DME and mortality.

Main Results:

• The in-hospital DME rate was 0.07% (84/120,278), with a 14% mortality rate for DME patients.
• Post-discharge DME occurred in 0.06% (54/98,147) of patients with 45-day follow-up, associated with a 3.7% mortality rate.
• Factors associated with DME included lower hospital procedure volume, Watchman 2.5 devices, larger LAA ostia, and smaller device-LAA size differences.

Conclusions:

• Watchman DME is a rare but serious complication associated with high mortality and frequent need for surgical retrieval.
• A significant proportion of DME events occur after hospital discharge, highlighting the need for vigilant monitoring.
• Risk mitigation strategies and readily available on-site cardiac surgical backup are crucial for managing Watchman DME events.