There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
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.
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.
Subjects (n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA2DS2-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]).
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.
The risk-benefit ratio of left atrial appendage closure (LAAC) versus systemic therapy (warfarin) for prevention of stroke, systemic embolism, and cardiovascular death in nonvalvular atrial fibrillation (NVAF) requires continued evaluation.