5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials.

Reddy, Vivek Y; Doshi, Shephal K; Kar, Saibal; Gibson, Douglas N; Price, Matthew J; Huber, Kenneth; Horton, Rodney P; Buchbinder, Maurice; Neuzil, Petr; Gordon, Nicole T; Holmes, David R

doi:10.1016/j.jacc.2017.10.021

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5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials.

Author(s): Vivek Reddy, Shephal K Doshi, Saibal Kar, Douglas Gibson, Matthew Price, Kenneth Huber, Rodney Horton, Maurice Buchbinder, Petr Neuzil, Nicole T Gordon, David Holmes

Publication date: 2017-12-19

Journal: Journal of the American College of Cardiology

Publisher: Elsevier BV

Keywords: warfarin, Watchman, atrial fibrillation, left atrial appendage, left atrial appendage closure, oral anticoagulation, stroke prevention

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Abstract

The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time.