Outcomes of Watchman device implantation in atrial fibrillation patients contraindicated for long-term anticoagulation: a single-center experience.

BACKGROUND

Left atrial appendage occlusion (LAAO) using the Watchman device is an established strategy for stroke prevention in atrial fibrillation (AF) patients at high thromboembolic risk who cannot tolerate long-term oral anticoagulation (OAC).

OBJECTIVES

To evaluate short-term clinical and echocardiographic outcomes of Watchman implantation in AF patients with contraindications to long-term OAC.

METHODS

We conducted a retrospective single-center study of AF patients who underwent Watchman implantation between September 01, 2023, and March 01, 2025. Baseline demographics, comorbidities, procedural characteristics, complications, antithrombotic strategies, and 45-day outcomes were analyzed. Outcomes were compared between patients with and without follow-up TEE. Data were analyzed using SAS v9.4. All tests were two-tailed, and a p-value <0.05 was considered statistically significant.

RESULTS

Among 10,078 AF patients, 120 underwent Watchman implantation; 105 met the inclusion criteria. The mean age was 75.8±7.8 years, and 46.7% were female. Implant success was 100%. Pericardial effusion occurred in 11 patients (10.5%, 95% CI 5.4-18.0%), including tamponade requiring pericardiocentesis in 2 patients (1.9%). Vascular access complications occurred in 3 patients (2.9%, 95% CI 0.6-8.1%). No device embolizations, device-related thrombi, or periprocedural strokes were observed. Most patients (88.5%) were discharged on dual antiplatelet therapy, while 3.8% received single antiplatelet therapy. At 45 days, 89 patients (84.8%) completed TEE; device position was stable in all. One patient (1.1%, 95% CI 0.03-6.1%) had a significant peridevice leak (>5 mm), and none had device-related thrombus. Clinical outcomes included one hemorrhagic stroke (1.1%) and eight rehospitalizations (7.6%, 95% CI 3.4-14.5%), unrelated to the device. No ischemic strokes were observed.

CONCLUSION

Watchman implantation achieved a 100% success rate with low complication rates and favorable short-term clinical and echocardiographic outcomes in AF patients contraindicated for long-term anticoagulation.