title: Primary and Secondary Stroke Prevention Using Left Atrial Appendage Closure with Watchman Devices in Atrial Fibrillation Patients: A Single Center Experience from Mainland China.
abstract: BACKGROUND
  Atrial fibrillation (AF) is associated with increased stroke risk resulting from cardiac embolism of the left atrial appendage (LAA). Stroke tends to recur in NVAF patients. Yet safety and feasibility of secondary stroke preventions with LAA closure (LAAC) have not been assessed in detail. This retrospective study was designed to compare the feasibility and safety of LAAC in primary and secondary stroke preventions, in a real-world setting of Chinese patients.
  
  
  METHODS
  From 2014 to 2015, non-valvular AF patients with CHA2DS2-VASc ≥1 were selected for percutaneous LAAC operations. Outcome observations of primary and secondary stroke preventions with Watchman devices were analyzed and compared.
  
  
  RESULTS
  Overall, 122 patients were included. LAAC with Watchman devices were attempted in 115 patients, of whom 68 were for primary stroke prevention and 47 were for secondary prevention. Both the CHA2DS2-VASc score and the HASBLED score were significantly higher in the secondary prevention group (4.09 ± 1.06 vs. 1.93 ± 1.09 for CHA2DS2-VASc and 1.83 ± 1.03 vs. 1.26 ± 0.87 for HASBLED, P < 0.01). In both groups LAAC were achieved with high successful rate (98.53% in the primary prevention group and 100% in the secondary prevention group, P > 0.05) and low complication rates. The stroke rates were at a low level in both groups (1.47% in primary prevention group vs. 2.13% in secondary prevention group, P > 0.05).
  
  
  CONCLUSIONS
  In our initial single-center experience, percutaneous LAA closure was a feasible and safe procedure for both primary and secondary stroke preventions in Chinese patients with nonvalvular AF.
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Keqiang
authors.initials: K
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
authors.forename: X I
authors.initials: XI
authors.lastname: Su
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D011322:Primary Prevention / Q000706:statistics & numerical data*; D011474:Prosthesis Design; D055502:Secondary Prevention / Q000706:statistics & numerical data; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: atrial fibrillation; interventional cardiology; left atrial appendage closure; stroke; thromboembolism