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Updated: May 7, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Age-specific outcomes after transcatheter left atrial appendage occlusion with the watchman device
Ritu Yadav1, Sia Savant2, Meghana Prakash2
1Midwestern University GME Consortium/Verde Valley Medical Center.
Insights
Older patients (age >75) undergoing transcatheter left atrial appendage occlusion (LAAO) face higher risks of major adverse cardiac events (MACE), mainly due to increased mortality. Procedural success rates were also lower in this age group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Transcatheter left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for patients with atrial fibrillation (AF).
- Limited data exists on the outcomes of LAAO in elderly patients (age >75 years).
Purpose of the Study:
- To evaluate the outcomes of LAAO in patients aged over 75 years compared to younger patients.
- To identify specific risks and procedural success rates in elderly individuals undergoing LAAO.
Main Methods:
- A retrospective analysis of 723 consecutive patients with AF undergoing LAAO between August 2015 and March 2020.
- Data collected included clinical, laboratory, procedural characteristics, medications, and 60-day outcomes.
- Primary outcome was a composite of major adverse cardiac events (MACE), including mortality, stroke, bleeding, and readmissions.
Main Results:
- Patients over 75 years had significantly higher MACE (17.1% vs. 11.5%, P=0.03), primarily driven by increased all-cause mortality (1.3% vs. 0%, P=0.04).
- Procedural success was lower in the >75 age group (92.2% vs. 96.2%, P=0.02).
- Stroke, major bleeding, and readmission rates did not differ significantly between the age groups.
Conclusions:
- Elderly patients (>75 years) undergoing LAAO experience worse outcomes, characterized by higher all-cause mortality and reduced procedural success.
- Further prospective studies are needed to validate these findings and explore strategies to improve outcomes in this population.
Background:
Transcatheter left atrial appendage occlusion (LAAO) has become a suitable alternative to anticoagulation in patients with atrial fibrillation (AF). However, outcomes among patients age > 75 years undergoing LAAO are lacking.
Methods:
We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020. Patient data including clinical, laboratory, procedural characteristics, medications and outcomes were collected. The primary composite outcome was major adverse cardiac events (MACE) including mortality, stroke, bleeding and readmissions at 60-days.
Results:
Mean age was 75 ± 8 years and 434 (60%) were males. Median CHA2DS2-VASc score was 4 (IQR: 4, 5) points and median HASBLED score was 4 (IQR: 3, 4) points. Composite MACE outcome was significantly higher among patients age > 75 years in both unadjusted (17.1% vs. 11.5%, P = 0.03) and adjusted (Odds Ratio = 1.59, 95% CI: 1.02 - 2.46, P = 0.04) analysis. Composite MACE was primarily driven by higher all-cause mortality (1.3% vs. 0, P = 0.04) among patients age > 75 years. The secondary outcome of procedural success was also lower among patients age > 75 years (92.2% vs. 96.2%, P = 0.02). The occurrence of stroke (P = 0.38), major bleeding (P = 0.29) and readmissions (P = 0.15) did not differ between patients age > 75 years and less than 75 years.
Conclusion:
Patients age >75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success. Future prospective studies evaluating these findings are warranted.
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