II. Indications
III. Background
- Watchman Device is placed percutaneously via femoral artery
- Device is inserted into and occludes the left atrial appendage
- Patient continues Anticoagulation for first 45 days after Watchman Device Placement
- Within 45 days, Myocardium grows over the device (after which Anticoagulation is no longer needed)
- Left atrial appendage Occlusion is an alternative to Anticoagulation for Cerebrovascular Accident Prevention
IV. Efficacy
- Compared with Atrial Fibrillation Anticoagulation
- Watchman Device is associated with lower Hemorrhagic Stroke rate
- Watchman Device is associated with lower cardiovascular mortality
- Watchman Device is similar to Atrial Fibrillation Anticoagulation in the Prevention of Ischemic Stroke
- Reduced stroke following cardiac surgery for other reasons (NNT 43 over 4 years)
V. Complications
- Overall complication rate 1 to 8%
- Complications are most typical immediately after placement
- Cardiac Perforation and Cardiac Tamponade
- Typically occurs at time of procedure
- Delayed presentation with slow leak is possible, but rare
- Percicarditis or Myocarditis
- Femoral Artery access site complications
- Inguinal Hematoma
- Arteriovenous Fistula
- Retroperitoneal Bleeding
- Cerebrovascular Accident
- Transiently increased risk in the first 45 days
- Device Embolization (rare)
- Typically occurs at time of procedure
VI. References
- DeMeester and Swaminathan in Herbert (2021) EM:Rap 21(10): 12-3