June 16, 2020Expert Review of Medical DevicesOpen Access

The WATCHMAN left atrial appendage closure device for patients with atrial fibrillation: current status and future perspectives

View Full Paper

Ask AI

Bookmark

Why the study?

The WATCHMAN percutaneous left atrial appendage closure device may serve as an alternative to oral anticoagulation to overcome disadvantages including bleeding risk in patients with atrial fibrillation.

Does percutaneous left atrial appendage closure with the Watchman device prevent stroke safely and effectively in patients with atrial fibrillation compared to oral anticoagulation?

Structured PICO

Does percutaneous left atrial appendage closure with the Watchman device prevent stroke safely and effectively in patients with atrial fibrillation compared to oral anticoagulation?

Population

Patients with atrial fibrillation at increased risk of stroke

Intervention

Percutaneous left atrial appendage closure (LAAC) with the Watchman device

Comparator

Oral anticoagulation (OAC)

Outcome

Stroke prevention

The Watchman LAAC device is a promising and effective alternative to oral anticoagulation for stroke prevention in atrial fibrillation, with potential to become a more frontline therapy.

Implication

LAAC with Watchman may be cost-effective versus OAC in select AF patients; leaves open need for updated prospective economic trials.

Abstract

INTRODUCTION: Atrial fibrillation (AF) is associated with an increased risk of stroke. Stroke prevention with oral anticoagulation (OAC) is recommended in AF patients at increased risk of stroke. The left atrial appendage (LAA) is the main source of thrombus formation in AF patients. The WATCHMAN percutaneous LAA closure (LAAC) device may serve as an alternative to OAC overcoming disadvantages including the risk of (major) bleeding. AREAS COVERED: This review will focus on LAAC with the Watchman device for stroke prevention in AF patients. Current status, available literature, clinical safety and efficacy will be summarized. Furthermore, the future perspectives of Watchman will be discussed. EXPERT OPINION: LAAC with Watchman appears a promising, safe, and effective alternative to OAC. Ongoing and future studies to consolidate the position of Watchman should focus on comparative safety and efficacy of different LAAC devices, patient selection, various post-procedural antithrombotic regimens, head-to-head comparisons with NOAC, better understanding of device-related thrombus, and the role of the LAA in the propagation of non-valvular AF. This research may attribute to a paradigm shift in which LAAC no longer serves as a 'last resort' treatment for AF patients ineligible for OAC but may serve as a second-line or even first-line treatment option for AF patients.