title: Clinical Results of Left Atrial Appendage Closure with Watchman Device in Patients with Atrial Fibrillation.
abstract: BACKGROUND
  In patient with non-valvular atrial fibrillation (AF), over 90% of thrombus accumulation originates in the left atrial appendage (LAA). Warfarin significantly reduces risk of stroke. However, long-term anticoagulant therapy is associated with a significant risk of major bleeding, particularly in elderly. Transcatheter occlusion of left atrial appendage with Watchman device has proved to be non-inferior to warfarin in preventing stroke in non-valvular AF patients. No previous report of transcatheter occlusion of LAA was found in Thailand
  
  
  OBJECTIVE
  To evaluate short-term results of left atrial appendage closure with the Watchman® device in patient with non-valvular AF performed at King Chulalongkorn Memorial Hospital (KCMH).
  
  
  METHODS
  Between November 2012 and December 2014, 12 consecutives patients underwent percutaneous transcatheter left atrial appendage closure. Data included patient's characteristics, embolic risk factors, bleeding risk score, procedural finding, complications, in-hospital outcomes, and antithrombotic management were retrospectively reviewed
  
  
  RESULTS
  Percutaneous LAA occlusion was successfully performed in all 12 patients. The mean age was 71.2 ± 8.1 years. The history of previous bleeding was seen in four patients (33%). All patients had good left ventricular systolic function. The mean CHADS2 score was 3.2 ± 1.3, the mean CHA2DS2-VASc score was 4.8 ± 1.6 and the mean HAS-BLED score was 2.5 ± 0.9. The average LAA orifice diameter was 21.7 ± 3.4 mm, and the median implant size was 27.0 mm. The compression ratio was 15.2 ± 6.2%. Three patients (25%) were performed under general anesthesia, nine patients (75%) were performed with local anesthesia. The averageprocedure time was 61.2 ± 18.5 minutes. The average fluoroscopy time was 6.8 ± 3.3 minutes. There was no device embolization or pericardial effusion. There was no periprocedural cerebral event, assess site bleeding, or death during hospital admission. Mild peridevice leak was observed in three patients (25%), and all had disappeared on TEE performed at the 45-day follow-up. The median length of stay was two days.
  
  
  CONCLUSIONS
  The result of the present study showed that percutaneous LAA occlusion with the Watchman device was feasible and safe. The successfulness of the procedures and periprocedural complications were similar to standard in literature.
authors.forename: Phattaraphong
authors.initials: P
authors.lastname: Pheerawong
authors.forename: Smonporn Boonyaratavej
authors.initials: SB
authors.lastname: Songmuang
authors.forename: Vorarit
authors.initials: V
authors.lastname: Lertsuwunseri
authors.forename: Sudarat
authors.initials: S
authors.lastname: Satitthummanid
authors.forename: Suphot
authors.initials: S
authors.lastname: Srimahachota
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D019468:Disease Management; D006801:Humans; D019919:Prosthesis Implantation / Q000379:methods*; D055989:Septal Occluder Device; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants