title: Left atrial anatomy and patient-related factors associated with adverse outcomes with the watchman device-a real world experience.
abstract: OBJECTIVE
  This study sought to identify patient and left atrial morphology specific factors associated with early complications for left atrial appendage occlusion with the Watchman™ (Boston Scientific, Natick, MA) device.
  
  
  BACKGROUND
  Oral anticoagulation (OAC) is recommended for patients with atrial fibrillation, however, long-term OAC compliance is poor. In randomized control trials, the Watchman™ device has demonstrated superiority over OAC with warfarin for all cause and cardiovascular mortality and hemorrhagic stroke. However, predictors of procedural complications have not yet been well established.
  
  
  METHODS
  There were 137 patients included in this study from a total of 141 consecutive patients prospectively enrolled in the registry between 8/1/2015 and 08/31/2016. Unadjusted, multivariate cox proportional hazards model was used for analysis. Primary end-point was a composite major adverse cardiac and cerebrovascular event (MACCE) defined to include death, stroke, major and life threatening bleeding, major vascular complications, device embolization, need for cardiovascular surgery, need for cardiopulmonary resuscitation, and significant pericardial effusion.
  
  
  RESULTS
  The primary endpoint was reached in 5.8% of patients. There were no device embolization and no strokes. Anterior chicken morphology (ACW) of the left atrial appendage (LAA) conferred a hazard ratio of 3.7 for MACCE and a body mass index >30 kg/m2significantly lowered the likelihood of a MACCE.
  
  
  CONCLUSIONS
  Certain LAA morphologies and patient characteristics increase the risk for a MACCE following left atrial appendage occlusion (LAAO) with the Watchman™ device. Anterior chicken wing morphology of the LAA and low BMI <30 kg/m2were independent predictors of MACCE in the multivariate regression model.
authors.affiliation: Division of Interventional Cardiology, University of Arizona at Banner University Medical Center, Phoenix, Arizona.
authors.forename: Shishir
authors.initials: S
authors.lastname: Murarka
authors.affiliation: Division of Interventional Cardiology, University of Arizona at Banner University Medical Center, Phoenix, Arizona.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Lazkani
authors.affiliation: Division of Interventional Cardiology, University of Arizona at Banner University Medical Center, Phoenix, Arizona.
authors.forename: Soundos
authors.initials: S
authors.lastname: Moualla
authors.affiliation: Division of Interventional Cardiology, University of Arizona at Banner University Medical Center, Phoenix, Arizona.
authors.forename: Divya Ratan
authors.initials: DR
authors.lastname: Verma
authors.affiliation: Division of Interventional Cardiology, University of Arizona at Banner University Medical Center, Phoenix, Arizona.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pershad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000473:pathology*; D001281:Atrial Fibrillation / Q000150:complications* / Q000473:pathology*; D015331:Cohort Studies; D057505:Embolic Protection Devices / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: LAAO; MACCE; Watchman