Procedure

Left Atrial Appendage Closure Device

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Left Atrial Appendage Closure Device, Left Atrial Appendage Closure, Left Cardiac Atrial Appendage Occlusion Procedure, Watchman Device, Watchman Procedure, Left Atrial Appendage Isolation, LAA Obliteration

  • Indications
  1. Atrial Fibrillation
  • Background
  1. Watchman Device is placed percutaneously via femoral artery
  2. Device is inserted into and occludes the left atrial appendage
    1. Patient continues Anticoagulation for first 45 days after Watchman Device Placement
    2. Within 45 days, Myocardium grows over the device (after which Anticoagulation is no longer needed)
  3. Left atrial appendage Occlusion is an alternative to Anticoagulation for Cerebrovascular Accident Prevention
  • Efficacy
  1. Compared with Atrial Fibrillation Anticoagulation
    1. Watchman Device is associated with lower Hemorrhagic Stroke rate
    2. Watchman Device is associated with lower cardiovascular mortality
    3. Watchman Device is similar to Atrial Fibrillation Anticoagulation in the Prevention of Ischemic Stroke
  2. Reduced stroke following cardiac surgery for other reasons (NNT 43 over 4 years)
    1. Whitlock (2021) N Engl J Med 384(22): 2081-91 [PubMed]
  • Complications
  1. Overall complication rate 1 to 8%
    1. Complications are most typical immediately after placement
  2. Cardiac Perforation and Cardiac Tamponade
    1. Typically occurs at time of procedure
      1. Delayed presentation with slow leak is possible, but rare
    2. Percicarditis or Myocarditis
    3. Femoral Artery access site complications
      1. Inguinal Hematoma
      2. Arteriovenous Fistula
      3. Retroperitoneal Bleeding
    4. Cerebrovascular Accident
      1. Transiently increased risk in the first 45 days
    5. Device Embolization (rare)
  • References
  1. DeMeester and Swaminathan in Herbert (2021) EM:Rap 21(10): 12-3