Latvian LAA Closure Registry- Five Years of Experience in High-Risk Patients

Aims: Left atrial appendage (LAA) closure with Watchman device and AMPLATZER Cardiac Plug (ACP) is proved to be safe and effective alternative for oral anticoagulant therapy in patients with atrial fibrillation (AF). In real practice in Latvia LAA closure is done in AF patients with higher stroke and bleeding risk compared to the largest LAA closure device studies. The purpose of the Latvian LAA closure registry was to assess long-term safety and efficacy of LAA closure method for stroke prevention in high-risk patients with atrial fibrillation.
Methods and Results: Single centre prospective non-randomized longitudinal cohort study of LAA closure with the Watchman device and ACP during five years. The registry collected data about clinical condition, primary and safety events (ischemic/hemorrhagic stroke, death, systemic embolism, device thrombosis or embolization, pericardial tamponade) from May 2010 to September 2015. In total 29 LAA closure cases were studied. Successful LAA closure was in 96.6% of cases (n=28). Watchman device was implanted in 50% and ACP in 50% of cases. Mean CHA2DS2-VASc score was 6.3(1.6) and HAS-BLED score - 3.3(1.0). Main indication for closure was recurrent ischemic stroke and low compliance in warfarin usage. Serious peri-procedural safety events (device embolization of Watchman device) occurred in one patient (n=1). Mean follow-up time was 38 (19.8) months, patients followed n=26. During 45 post-procedural days there was one (n=1) device thrombosis. After day 45 ischemic stroke occurred in 2 patients (2.3 per 100 patient-years), non-cardiovascular death (from liver cancer) in one patient (1.2 per 100 patient-years).
Conclusions: LAA closure is a safe and effective method for thromboembolic stroke prevention in patients with atrial fibrillation and high risk of stroke and bleeding.