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Updated: Jun 18, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
A Current Perspective on Left Atrial Appendage Closure Device Infections: A Systematic Review
Yusuf Ziya Sener1, Sumeyye Fatma Ozer2, Gizem Karahan3
1Department of Cardiology, Thoraxcentrum, Erasmus MC, Rotterdam, the Netherlands.
Insights
Left atrial appendage (LAA) closure device infections are rare but serious complications. Management often requires device removal, and outcomes can be poor, highlighting the need for further research.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Left atrial appendage (LAA) closure is a standard treatment for atrial fibrillation (AF) patients at high risk of thromboembolism.
- LAA occlusion device infection is a rare but serious complication with limited data on management and outcomes.
Purpose of the Study:
- To summarize the existing literature on LAA occlusion device infections.
- To highlight knowledge gaps in the diagnosis, management, and outcomes of these infections.
Main Methods:
- A comprehensive literature search was conducted across major biomedical databases (PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Central).
- Included case reports with data on diagnosis, treatment, and outcomes of LAA occlusion device infections.
Main Results:
- Analyzed 12 case reports involving 12 patients (mean age 73.6 years, 50% male).
- Watchman device was most common; median time to infection was 6.6 months. Staphylococcus aureus was the most frequent pathogen.
- Device removal occurred in 7 cases; mortality was 25% (3/12), all during hospitalization.
Conclusions:
- LAA closure device infections are rare but associated with high complication and mortality rates.
- Device removal is recommended in appropriate cases; antibiotic therapy alone is suitable for selected patients.
- Further research is needed to establish clear diagnostic and treatment strategies based on pathogens and patient status.
Purpose:
Left atrial appendage (LAA) closure has become the standard of care for patients with atrial fibrillation (AF) at high risk of thromboembolism who are intolerant or unwilling to take anticoagulants. LAA occlusion device infection is a challenging complication, and there is a paucity of data on the management and outcomes of LAA occlusion device infection. We aimed to summarize the existing literature and highlight the knowledge gap in this area.
Methods:
A detailed search was conducted through the databases PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Central using the relevant keywords. All cases with presented data regarding diagnosis, treatment, and outcome were included from the reports.
Results:
The analysis included 12 case reports encompassing a total of 12 patients. The mean age was 73.6 ± 11.0 years, and 50% of the cases were male. The most commonly implanted device was the Watchman (in eight of the 12 cases). The median time between LAA closure and infection was 6.6 (0.2-36) months. Transesophageal echocardiography was diagnostic in all cases, and positron emission tomography/computed tomography (PET/CT) was useful in diagnosis in three cases. The most common pathogen was Staphylococcus aureus (n = 7). The LAAC device was removed in seven cases; one patient refused surgery, and in the other three cases, removal of the device was not considered appropriate due to the patient's poor condition. Data on whether the device was removed could not be retrieved for one patient. Mortality occurred in three cases (25%), and all deaths occurred during hospitalization.
Conclusion:
LAA closure device infections are rare but carry a high risk of complications and mortality. Treatment should include device removal in appropriate cases, and antibiotherapy alone should be considered only in selected cases. Further studies are needed to clarify diagnostic and treatment strategies based on the causative pathogens and patient status.
