Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;32(1):83-92.
doi: 10.1111/jce.14804. Epub 2020 Nov 11.

Contemporary procedural trends of Watchman percutaneous left atrial appendage occlusion in the United States

Muhammad Bilal Munir  1 , Muhammad Zia Khan  2 , Douglas Darden  1 , Deepak K Pasupula  3 , Sudarshan Balla  2 , Frederick T Han  1 , Ryan Reeves  1 , Jonathan C Hsu  1
Affiliations

Contemporary procedural trends of Watchman percutaneous left atrial appendage occlusion in the United States

Muhammad Bilal Munir et al. J Cardiovasc Electrophysiol. 2021 Jan.

Abstract

Objective: To determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015.

Background: The risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy.

Methods: This was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality.

Results: A total of 17 700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1195 in 2015 to 11 165 devices in 2017, p < .01). A significant decline in the rate of complications (from 26.4% in 2015% to 7.9% in 2017, p < .01) and inpatient mortality (from 1.3% in 2015% to 0.1% in 2017, p < .01) were noted. Predictors of in-hospital mortality included a higher CHA2 DS2 -VASc score (odds ratio [OR]: 2.61 per 1-point increase, 95% confidence interval [CI]: 1.91-3.57), chronic blood loss anemia (OR: 3.63, 95% CI: 1.37-9.61) and coagulopathy (OR: 4.90, 95% CI: 2.32-10.35).

Conclusion: In contemporary United States clinical practice, Watchman utilization has increased significantly since approval in 2015, while complications and in-patient mortality have declined.

Keywords: Watchman; complications; mortality; national trends.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Number of Watchman procedures over the study years
FIGURE 2
FIGURE 2
Trends in mortality after Watchman implant from years 2015 to 2017
FIGURE 3
FIGURE 3
Mean length of stay during Watchman implantation admissions from years 2015 to 2017
FIGURE 4
FIGURE 4
Adjusted mean cost of stay during Watchman implantation admissions from years 2015 to 2017
FIGURE 5
FIGURE 5
Predictors of in-hospital mortality associated with Watchman implantation from years 2015 to 2017
See this image and copyright information in PMC

References

    1. Mozaffarian D, Benjamin EJ, Go AS, et al.Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e360. - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, et al.Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129:837–847. - PMC - PubMed
    1. Saposnik G, Gladstone D, Raptis R, Hart RG. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke. 2013;44:99–104. - PubMed
    1. Seet RC, Zhang Y, Wijdicks EF, Rabinstein AA. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis. Arch Neurol. 2011;68:1454–1458. - PubMed
    1. Alkhouli M, Noseworthy PA, Rihal CS, Holmes DR Jr. Stroke prevention in nonvalvular atrial fibrillation: a stakeholder perspective. J Am Coll Cardiol. 2018;71:2790–2801. - PubMed