Left Atrial Appendage Closure Device

Aka: Left Atrial Appendage Closure Device, Left Atrial Appendage Closure, Left Cardiac Atrial Appendage Occlusion Procedure, Watchman Device, Watchman Procedure, Left Atrial Appendage Isolation, LAA Obliteration

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II. Indications

  1. Atrial Fibrillation

III. Background

  1. Watchman Device is placed percutaneously via femoral artery
  2. Device is inserted into and occludes the left atrial appendage
    1. Patient continues Anticoagulation for first 45 days after Watchman Device Placement
    2. Within 45 days, Myocardium grows over the device (after which Anticoagulation is no longer needed)
  3. Left atrial appendage Occlusion is an alternative to Anticoagulation for Cerebrovascular Accident Prevention

IV. Efficacy

  1. Compared with Atrial Fibrillation Anticoagulation
    1. Watchman Device is associated with lower Hemorrhagic Stroke rate
    2. Watchman Device is associated with lower cardiovascular mortality
    3. Watchman Device is similar to Atrial Fibrillation Anticoagulation in the Prevention of Ischemic Stroke
    4. Reduced stroke following cardiac surgery for other reasons (NNT 43 over 4 years)
  2. References
    1. Whitlock (2021) N Engl J Med 384(22): 2081-91 [PubMed]
    2. Wazni (2025) N Engl J Med 392(13): 1277-87 [PubMed]

V. Complications

  1. Overall complication rate 1 to 8%
    1. Complications are most typical immediately after placement
  2. Cardiac Perforation and Cardiac Tamponade
    1. Typically occurs at time of procedure
    2. Delayed presentation with slow leak is possible, but rare
  3. Percicarditis or Myocarditis
  4. Femoral Artery access site complications
    1. Inguinal Hematoma
    2. Arteriovenous Fistula
    3. Retroperitoneal Bleeding
  5. Cerebrovascular Accident
    1. Transiently increased risk in the first 45 days
  6. Device Embolization (rare)

VI. Management

  1. Recurrent Atrial Fibrillation in patient with LAAO and no Anticoagulation
    1. Follow same guidelines for cardioversion for patients without LAAO
    2. Presentation <48 hours from Atrial Fibrillation onset
      1. May cardiovert without TEE and anticoagulate for 4 weeks after cardioversion
      2. Discuss with general cardiology or electrophysiology
    3. Presentation >48 hours from Atrial Fibrillation onset
      1. Anticoagulate and plan for TEE and cardioversion
    4. References
      1. Swaminathan, Shoenberger and Haywood (2026) Mailbag, EM:Rap, 3/30/2026

VII. References

  1. DeMeester and Swaminathan in Herbert (2021) EM:Rap 21(10): 12-3
  2. [PubMed]

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