Karen P. Phillips a , * , 1 , Teguh Santoso b , Prashanthan Sanders c , Jeffrey Alison d , Jason Leung Kwai Chan e , Hui-Nam Pak f , Mann Chandavimol g , Kenneth M. Stein h , Nicole Gordon h , Omar Bin Razali i
09 April 2019
BMI, body mass index, CI, confidence interval, LAA, left atrial appendage, NOAC, Novel oral anticoagulant, NVAF, non-valvular atrial fibrillation, OAC, oral anticoagulation, SAE, serious adverse events, SE, systemic embolism, TOE, transoesophageal echocardiography, TIA, transient ischaemic attack, WASP, The Asia-Pacific Registry on WATCHMAN Outcomes in Real-Life Utilization, Atrial fibrillation, Ischaemic stroke, Left atrial appendage, LAA device closure, Anticoagulant therapy
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 (CHA 2DS 2-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]).