Anterior chicken wing morphology of the left atrial appendage was associated with an increased risk of MACCE (HR 3.7) following Watchman device implantation, whereas BMI >30 kg/m2 lowered the risk.
Cohort (n=137)
What patient and left atrial morphology factors are associated with early complications following left atrial appendage occlusion with the Watchman device in patients with atrial fibrillation?
Anterior chicken wing morphology of the left atrial appendage and BMI <30 kg/m2 are independent predictors of major adverse events following LAA occlusion with the Watchman device.
Hazard Ratio: 3.7
Objective This study sought to identify patient and left atrial morphology specific factors associated with early complications for left atrial appendage occlusion with the Watchman™ (Boston Scientific, Natick, MA) device. Background Oral anticoagulation (OAC) is recommended for patients with atrial fibrillation, however, long‐term OAC compliance is poor. In randomized control trials, the Watchman™ device has demonstrated superiority over OAC with warfarin for all cause and cardiovascular mortality and hemorrhagic stroke. However, predictors of procedural complications have not yet been well established. Methods There were 137 patients included in this study from a total of 141 consecutive patients prospectively enrolled in the registry between 8/1/2015 and 08/31/2016. Unadjusted, multivariate cox proportional hazards model was used for analysis. Primary end‐point was a composite major adverse cardiac and cerebrovascular event (MACCE) defined to include death, stroke, major and life threatening bleeding, major vascular complications, device embolization, need for cardiovascular surgery, need for cardiopulmonary resuscitation, and significant pericardial effusion. Results The primary endpoint was reached in 5.8% of patients. There were no device embolization and no strokes. Anterior chicken morphology (ACW) of the left atrial appendage (LAA) conferred a hazard ratio of 3.7 for MACCE and a body mass index >30 kg/m2 significantly lowered the likelihood of a MACCE. Conclusion Certain LAA morphologies and patient characteristics increase the risk for a MACCE following left atrial appendage occlusion (LAAO) with the Watchman™ device. Anterior chicken wing morphology of the LAA and low BMI <30 kg/m2 were independent predictors of MACCE in the multivariate regression model.
Murarka et al. (2017) conducted a cohort in Atrial fibrillation (n=137). Anterior chicken wing morphology of the left atrial appendage vs. Other left atrial appendage morphologies was evaluated on Composite major adverse cardiac and cerebrovascular event (MACCE) including death, stroke, major and life threatening bleeding, major vascular complications, device embolization, need for cardiovascular surgery, need for cardiopulmonary resuscitation, and significant pericardial effusion (HR 3.7). Anterior chicken wing morphology of the left atrial appendage was associated with an increased risk of MACCE (HR 3.7) following Watchman device implantation, whereas BMI >30 kg/m2 lowered the risk.