Procedural Success and Complication Rates of LAA Closure Devices

The WATCHMAN left atrial appendage (LAA) closure device has high procedural success and low rates of complications, according to the results of the WATCHMAN POST-FDA APPROVAL study presented Nov. 2 at TCT 2016 and simultaneously published in the Journal of the American College of Cardiology.

David R. Holmes Jr., MD, MACC, et al., evaluated the acute procedural performance and complication rates for all WATCHMAN cases (n=3822) performed in the U.S. since the device was approved by the U.S. Food and Drug Administration (FDA) in March 2015. LAA closure procedure requires the presence of a manufacturer clinical specialist, and procedural parameter and peri-procedural complication data are collected as part of a standardized process.

The results of the study showed that implantation was successful in 3,653 patients (95.6 percent) with a median procedure time of 50 minutes. New, non-clinical trial implanters accounted for 71 percent of the implanting physicians, performing 50 percent of the procedures. Further, there were 39 pericardial tamponades, three procedure-related strokes, nine device embolizations and three procedure-related deaths.

In an accompanying editorial comment, Jacqueline W. L. Saw, MD, FACC, et al., note that these “results are remarkably favorable for the earliest phase of widespread dissemination of this technology,” but that “there are several concerns relating to the study design [ – that it is not a prospective registry with patient informed consent – which] should be considered when interpreting the findings.”

The results of the AMULET Trial, presented Nov. 2 at TCT 2016, also showed high implant success rate and low major adverse events for percutaneous transcatheter LAA closure with the Amplatzer Amulet device in the prevention of stroke in patients with non-valvular atrial fibrillation. At 1 – 3 month follow-up of 1073 patients, the majority of patients were on antiplatelet therapy only and the CoreLab analyzed results of transesophageal echocardiography showed a closure rate of 99 percent.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Transcatheter Cardiovascular Therapeutics, Atrial Appendage, Atrial Fibrillation, Cardiac Surgical Procedures, Registries, Stroke, Warfarin, Cardiac Tamponade, Echocardiography, Transesophageal, Prospective Studies, Research Design, United States Food and Drug Administration

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