P3849Watchman implantation in patients with very high stroke risk

Abstract

Background: The Watchman device is increasingly used for stroke prevention in atrial fibrillation. Little is known about the role of this device in patients with very high stroke risk. Purpose: To assess the role of Watchman in patients with CHADSVASC ≥5. Methods: All patients undergoing Watchman implant at our institution were enrolled in a prospective registry. We included all 104 Watchman recipients with CHADSVASC ≥5. Results: Median age was 78.5±6.4 years and 56% were male: mean CHADSVASC 5.7±0.9 (quartiles 5-6), mean HASBLED 4.0±1.0 (quartiles 3-5). Indications for implantation were significant prior bleeding in 74%, irreversible bleeding condition in 21% and unacceptable stroke risk alone in 15%. All but 2 patients completed 45 days of anticoagulation: One had retroperitoneal hematoma 30 days post implantant on warfarin and one had intracranial hemorrhage resulting in death (original implant indication was recurrent falls) 10 days post implant on apixaban. Of those who completed 45 days of anticoagulation, 58 (57%) used warfarin and 44 (43%) a novel oral anticoagulant. Transesophageal echocardiogram at 45 days revealed no peridevice leak >5mm or device related thrombosis. At 1 year of follow up, stroke occured in 3 (2.8%) patients at 90, 120 and 270 days after procedure. Conclusion: In a population of patients with mean CHADSVASC of 5.7, Watchman implantation appeared to be efficacious, with a residual annual stroke risk of only 2.8%. This population would otherwise have an estimated annual risk of stroke of ≈12% off anticoagulation and >4% on warfarin.