Percutaneous left atrial appendage closure with the watchman device: 12 month outcomes from the wasp asia-pacific registry.

Abstract

Background: Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk patients with non-valvular atrial fibrillation. Method(s): The objective of the multicentre WASP registry was to obtain clinical data on procedural success and complications, and long-term patient outcomes during real world clinical use in patients across the Asia-Pacific region. Result(s): 201 patients were enrolled in 2014-2015 from 9 centres in Australia, Indonesia, Malaysia, Hong Kong, South Korea, Thailand and Kingdom of Saudi Arabia. Subjects were at high risk of stroke (average CHA2DS2-VASc: 3.9 +/-1.6) and moderate-to-high risk of bleeding (average HAS-BLED score: 2.1 +/-1.2). More than one third of subjects (37.6%) had a history of TIA, ischaemic or haemorrhagic stroke; 71% of patients were deemed unsuitable for long-term oral anticoagulant. Post-implant 57% of patients were prescribed a short-term oral anticoagulant, 38% antiplatelet therapy and 5% no therapy. The device was successfully deployed in 98.5% of patients with no or minimal residual flow achieved in 100% of patients studied at follow-up. The 7-day device or procedure-related SAE rate was 2.0%. There were no peripro-cedural stroke/TIAs or device embolisation. Two patients (1%) required pericardiocentesis. The 12-month mortality rate was 5.2% with 1 procedure/device-related death at 32 days due to oesophageal tear. The 12-month stroke rate was 1.8%. Conclusion(s): Real world experience of left atrial appendage closure with the WATCHMAN device has demonstrated a high successful implant rate and low peri-procedural risk in an Asia-Pacific registry. Long-term outcomes show effi-cacious stroke prevention and are consistent with other WATCHMAN studies.