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Updated: Aug 15, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
The Canadian WATCHMAN Registry for Percutaneous Left Atrial Appendage Closure
Jacqueline Saw1, Taku Inohara1, Thomas Gilhofer1
1Vancouver General Hospital, Vancouver, British Columbia, Canada.
Background:
Access to left atrial appendage closure (LAAC) in Canada is limited, due to funding restrictions. This work aimed to assess Canadian clinical practice on patient selection, postprocedural antithrombotic therapy, and safety and/or efficacy with WATCHMAN device implantation.
Methods:
Seven Canadian centres implanting the WATCHMAN device participated in this prospective multicentre, observational registry. All procedures were done under general anesthesia with transesophageal echocardiography guidance. Patients were prospectively followed for 2years. The long-term stroke rate was compared with the expected rate based on the CHA2DS2-VASc score.
Results:
A total of 272 patients who underwent LAAC with the WATCHMAN device between December 2013 and August 2019 (mean age: 75.4 years [standard deviation {SD}: 8.75]; male, 63.2%; CHA2DS2-VASc score: 4.35 [SD: 1.64]; HAS-BLED score: 3.55 [SD: 0.94]) were included. Most patients (90.4%) had prior history of bleeding (major, 80.5%; minor, 21.7%). The WATCHMAN device was successfully implanted in 269 patients (98.9%), with a few procedure-related complications, including 5 pericardial effusions requiring drainage (1.8%), and 1 death (0.4%; 22 days post-LAAC from respiratory failure). Post-LAAC antithrombotic therapy included dual antiplatelet therapy in 70.6%, single antiplatelet therapy in 18.4%, and oral anticoagulation in 13.6%. During the follow-up period (mean: 709.7 days [SD: 467.2]), an 81.4% reduction of the ischemic stroke rate occurred, based on the expected rate from the CHA2DS2-VASc score (6.0% expected vs 1.1% observed). Device-related thrombus was detected in 1.8%.
Conclusions:
The majority of Canadian patients who underwent LAAC had oral anticoagulation contraindication due to prior bleeding, and most were safely treated with antiplatelet therapy post-LAAC, with a low device-related thrombus incidence. Long-term follow-up demonstrated that LAAC achieved a significant reduction in ischemic stroke rate.
Insights
Left atrial appendage closure (LAAC) in Canada using the WATCHMAN device is safe and effective for patients with bleeding risks. This procedure significantly reduced ischemic stroke rates, offering a vital alternative to oral anticoagulation.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Practice
Background:
- Access to left atrial appendage closure (LAAC) in Canada is restricted due to funding limitations.
- This study evaluated Canadian clinical practice for WATCHMAN device implantation, focusing on patient selection and post-procedure care.
- Prior bleeding history is a common contraindication for oral anticoagulation in patients undergoing LAAC.
Purpose of the Study:
- To assess Canadian clinical practice regarding patient selection for LAAC with the WATCHMAN device.
- To evaluate postprocedural antithrombotic therapy strategies following WATCHMAN implantation.
- To determine the safety and efficacy of WATCHMAN device implantation in a Canadian cohort.
Main Methods:
- A prospective, multicentre, observational registry involving seven Canadian centres implanting the WATCHMAN device.
- Patients were followed for two years, with stroke rates compared to expected rates based on CHA2DS2-VASc scores.
- Procedures were performed under general anesthesia with transesophageal echocardiography guidance.
Main Results:
- 272 patients (mean age 75.4 years) underwent LAAC; 98.9% had successful WATCHMAN implantation.
- Most patients (90.4%) had a history of bleeding, with 80.5% experiencing major bleeding.
- An 81.4% reduction in ischemic stroke rate was observed (1.1% observed vs. 6.0% expected), with a low incidence of device-related thrombus (1.8%).
Conclusions:
- The majority of Canadian LAAC patients had contraindications to oral anticoagulation due to prior bleeding.
- Most patients were safely managed with antiplatelet therapy post-LAAC, demonstrating a low incidence of device-related thrombus.
- Long-term follow-up confirmed that LAAC significantly reduces the ischemic stroke rate.
