Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry

Abstract

Background Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN implant in the Asia-Pacific region. Methods Data were collected from consecutive patients across 9 centres. Major endpoints included procedural success, safety and long-term outcomes including occurrence of bleeding, stroke/transient ischaemic attack/systemic embolism and all-cause mortality. Results Subjects ( n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA 2 DS 2 -VASc: 3.9 ± 1.7), elevated bleeding risk (HAS-BLED: 2.1 ± 1.2) with 53% patients from Asian countries. Successful implantation occurred in 98.5% of patients; 7-day device/procedure-related SAE rate was 3.0%. After 2 years of follow-up, the rates of ischaemic stroke/TIA/SE and major bleeding were 1.9 and 2.2 per 100-PY, respectively, representing relative reductions of 77% and 49% versus expected rates per risk scores. The relative risk reductions versus expected rates were more pronounced in Asians vs. Non-Asians (89% vs 62%; 77% vs 14%). Other significant findings included larger mean LAA ostium diameter for Asians vs. Non-Asians (23.4 ± 4.1 mm vs. 21.2 ± 3.2 mm, p < 0.001) and hence requirement for larger median device size (27 mm for Asians, 24 mm for non-Asians [ p < 0.0001]). Conclusion Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort.

Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II

“…Comparison of results from the series of patients who underwent LAAC may show variations in the percentage of events during follow-up. In spite of some consistency in the relative reduction of stroke (60-80% of CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) scores), there was a higher variability in bleeding events among the series from the first year of follow-up, with major bleeding events ranging from 2.2% to 10% per year [2][3][4].…”

Efficacy and Safety of Left Atrial Appendage Closure With WATCHMAN in Japanese Nonvalvular Atrial Fibrillation Patients ― Final 2-Year Follow-up Outcome Data From the SALUTE Trial ―

“…quently in SALUTE. 8 Recently, the WASP registry reported that the mean LAA diameter was significantly larger in Asians and the median device size used was 27 mm for Asians vs. 24 mm for non-Asians, 10 suggesting that the LAA in Asians might be larger than in other races.…”

Two-Year Outcome From Combining Cryoballoon Ablation and Left Atrial Appendage Closure: CLACBAC Study

“…Only one patient experienced WATCHMAN device deployment failure due to an oversized LAA. A WASP study showed that the average LAA ostium diameter was significantly larger in Asian populations, thus requiring larger WATCHMAN devices ( 23 ). Therefore, based on our experience, we recommend the thorough pre-procedural evaluation of LAA morphology as well as larger LAAC devices to accommodate LAA in Asian populations.…”