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Contemporary Procedural Trends of Watchman Percutaneous Left Atrial Appendage Occlusion in the United States
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  • Muhammad Bilal Munir,
  • Muhammad Khan,
  • Douglas Darden,
  • Deepak Kumar Pasupula,
  • Sudarshan Balla,
  • Frederick Han,
  • Ryan Reeves,
  • Jonathan Hsu
Muhammad Bilal Munir
West Virginia University School of Medicine

Corresponding Author:[email protected]

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Muhammad Khan
West Virginia University Hospitals
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Douglas Darden
University of California San Diego Health System
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Deepak Kumar Pasupula
UPMC Passavant
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Sudarshan Balla
West Virginia University Hospitals
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Frederick Han
University of California San Diego Health System
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Ryan Reeves
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Jonathan Hsu
University of California, San Diego
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Objective: To determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015. Background: The risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy. Methods: This was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality. Results: A total of 17,700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1,195 in 2015 to 11,165 devices in 2017, p < 0.01). A significant decline in the rate of complications (from 26.4% in 2015 to 7.9% in 2017, p < 0.01) and inpatient mortality (from 1.3% in 2015 to 0.1% in 2017, p < 0.01) were noted. Predictors of in-hospital mortality included a higher CHA₂DS₂-VASc score (OR 2.61 per 1-point increase, 95% CI 1.91-3.57), chronic blood loss anemia (OR 3.63, 95% CI 1.37-9.61) and coagulopathy (OR 4.90, 95% CI 2.32-10.35). Conclusion: In contemporary United States clinical practice, Watchman utilization has increased significantly since approval in 2015, while complications and in-patient mortality have declined.
12 Sep 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Sep 2020Submission Checks Completed
14 Sep 2020Assigned to Editor
18 Sep 2020Reviewer(s) Assigned
12 Oct 2020Review(s) Completed, Editorial Evaluation Pending
18 Oct 2020Editorial Decision: Revise Minor
20 Oct 20201st Revision Received
21 Oct 2020Submission Checks Completed
21 Oct 2020Assigned to Editor
21 Oct 2020Reviewer(s) Assigned
01 Nov 2020Review(s) Completed, Editorial Evaluation Pending
02 Nov 2020Editorial Decision: Accept
Jan 2021Published in Journal of Cardiovascular Electrophysiology volume 32 issue 1 on pages 83-92. 10.1111/jce.14804