Contemporary Procedural Trends of Watchman Percutaneous Left Atrial
Appendage Occlusion in the United States
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 1,195 in 2015
to 11,165 devices in 2017, p < 0.01). A significant decline in
the rate of complications (from 26.4% in 2015 to 7.9% in 2017, p
< 0.01) and inpatient mortality (from 1.3% in 2015 to 0.1%
in 2017, p < 0.01) were noted. Predictors of in-hospital
mortality included a higher CHA₂DS₂-VASc score (OR 2.61 per 1-point
increase, 95% 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.