Highlights from

ACC 2021

American College of Cardiology Annual Congress 2021

Virtual 15-17 May 2021

Favourable outcomes with transcatheter atrial appendage occlusion

Summary: Data from the National Cardiovascular Data Registry (NCDR) left atrial appendage occlusion (LAAO) registry showed a decrease of thromboembolic events 1 year after receiving a WATCHMAN implant.1 These 1-year clinical outcomes suggest a favourable alternative to anticoagulants for patients with non-valvular atrial fibrillation who are unable to take oral anticoagulants.

The WATCHMAN device is a permanent device that is implanted into the left atrial appendage to prevent clot formation. It was approved by the FDA in 2015 based upon favourable data from the PROTECT AF (n=463 implants) and the PREVAIL (n=269 implants) trials. It has also been approved for Medicare/Medicaid coverage in the US, but the eligibility criteria to quality for reimbursement differ from the inclusion criteria used in the PROTECT AF and PREVAIL trials. Therefore, there was a need to monitor the clinical outcomes achieved under these different criteria. Furthermore, data on long-term safety and effectiveness of the WATCMAN device is lacking. Dr Matthew Price (Scripps Clinic, California, US) shared the results of the observational cohort study, which examined the rates of thromboembolic and bleeding events at 1-year follow up in 36,681 patients who received a WATCHMAN device and who were in the LAAO registry. Endpoints examined were the 1-year rate of ischaemic stroke (1.53%; 95% CI 1.40-1.66), 1-year rate of major bleeding (6.2%; 95% CI 6.0-6.5), and 1-year rate of mortality (8.52%; 95% CI 8.23-8.81). There was a 77% risk reduction in ischaemic stroke with LAAO compared with the expected rate when left untreated. Dr Price concluded that these data support the early-to-mid-term clinical effectiveness of transcatheter LAAO as it being employed at this time in the US.

  1. Price M. One-year clinical outcomes following watchman transcatheter left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a report from the NCDR LAAO registry. ACC 2021 Scientific Session, 15-17 May 2021

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Article image: Sam Edwards

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