Infection Rate and Outcomes of Watchman Devices: Results from a Single Center 14-Year Experience

Abstract

Background: Left atrial appendage occlusion with the Watchman device is an alternative strategy for stroke risk reduction in patients with non-valvular atrial fibrillation. There are rare case reports of Watchman associated infection. Currently, there is no formal study that evaluated the incidence and outcomes of Watchman-related infections. Methods: All patients who underwent Watchman implantation over a 14 year study period (July 2004 through December 2018) comprised our cohort. Baseline characteristics, procedural data, and post-implantation events were identified. Primary study outcomes included Watchman related infection, other cardiovascular device related infection, bacteremia, and mortality. Results: A total of 181 patients with an average age of 75, and a median CHA2DS2-VASc Score of 4 (interquartile range 2) and a median HAS-BLED Score of 3 (interquartile range 1), were included for analysis. A total of 534.7 patient years of follow up was accrued with an average of 2.9 years per patient. The most common indications for implantation included gastrointestinal bleeding (56 patients; 30.9%) and intracerebral bleeding (51 patients; 28.2%). During follow up, 38 patients (21%) died. Six developed evidence of bacteremia. Only one developed an implantable cardioverter defibrillator (ICD) infection that required complete system extraction. None of the cohort developed Watchman-related device infection during the study period. Conclusion: In a single center study spanning a 14 year period, we report no Watchman-related devices infections. This is despite the presence of patients with bacteremia, as well as an ICD infection requiring extraction. These data suggest that Watchman devices are extremely unlikely to become infected.

Emerging Concepts on Infection of Novel Cardiac Implantable Devices

“…In specific circumstances such as with prior life-threatening hemorrhage or contraindications to long term oral anticoagulants, Left Atrial Appendage Occluder (LAAO) devices are the mainstay of treatment for AF-related embolism [67]. The most widely used LAAOthe WATCHMAN device (Boston Scientific, Marlborough, MA, USA)-was found to be non-inferior to oral antico-agulant therapy in the prevention of stroke, systemic embolism, and cardiovascular death [68][69][70], and with very low risk of infection, even in patients with BSI [71].…”