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Updated: May 4, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Incidence and predictors of device-related thrombus after left atrial appendage closure with Watchman device
Jakub Maksym1, Piotr Scisło1, Agnieszka Kapłon-Cieślicka1
1First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Insights
Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is rare but linked to patient factors. Lower ejection fraction, reduced LAA emptying velocity, and deeper implantation predict DRT in atrial fibrillation patients.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Left atrial appendage closure (LAAC) using the Watchman device is a strategy to prevent thromboembolism in patients with atrial fibrillation (AF).
- A potential complication is the development of device-related thrombus (DRT) on the atrial surface of the implanted device.
Purpose of the Study:
- To determine the incidence of device-related thrombus (DRT) in patients who underwent LAAC with the Watchman device.
- To identify patient and procedural predictors associated with DRT formation.
Main Methods:
- Retrospective analysis of 78 patients with AF who underwent LAAC with the first-generation Watchman 2.5 device.
- Patients received antiplatelet therapy post-procedure.
- Transesophageal echocardiography (TEE) was used for clinical follow-up to assess for DRT.
Main Results:
- Device-related thrombus (DRT) was observed in 6.4% of patients.
- Predictors of DRT included lower ejection fraction, reduced left atrial appendage (LAA) emptying velocity, greater implantation depth, larger LAA dimensions, and younger patient age.
- Patients with DRT had significantly lower ejection fraction (p=0.005), lower LAA emptying velocity (p=0.009), and greater implantation depth (p<0.001).
Conclusions:
- Device-related thrombus (DRT) following Watchman device implantation for LAAC is an infrequent complication.
- Specific patient characteristics and procedural factors appear to be associated with DRT development.
- Further investigation in larger cohorts is warranted to confirm these findings and refine risk stratification.
Introduction:
Left atrial appendage closure (LAAC) with Watchman device prevents thromboembolism in patients with atrial fibrillation (AF). However, thrombus may develop on the atrial surface of the device.
Aim:
To investigate the incidence and predictors of device-related thrombus (DRT) in patients with AF who were treated with LAAC.
Material And Methods:
Ninety-one consecutive patients with AF underwent LAAC procedure using first-generation Watchman 2.5 device followed by antiplatelet therapy. In our analysis we have included all patients (n = 78) who had clinical follow-up visits with transesophageal echocardiography (TEE) after the procedure.
Results:
The median (IQR) CHA2DS2-VASc score was 4 (4.0-6.0) and HAS-BLED score was 3 (3.0-4.0). DRTs were observed in 5 (6.4%) patients. When compared with patients without DRT, those with DRT presented more often with lower median ejection fraction (40% (23.5-45.5) versus 55% (48.0-60.0); p = 0.005), lower emptying velocity of LAA (25 cm/s (17.5-27.0) versus 53 cm/s (26.5-78.0); p = 0.009), and with greater depth of implantation (18 mm (14.0-20.5) versus 8 mm (5.0-11.0); p < 0.001). Furthermore, patients with DRT had greater depth of LAA (35 mm (29.5-41.0) versus 29 mm (25.5-31.0); p = 0.003), greater mean (SD) dimension in 900 (22.4 mm (3.2) versus 19 mm (2.7); p = 0.02). Patients with DRT were also younger than those without DRT (67.4 years (7) versus 75 years (8.3), p = 0.045).
Conclusions:
The DRT after Watchman device implantation remains a rare complication. Its formation was related to several patient and procedural characteristics, which need to be confirmed in larger studies.
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