Left atrial appendage occlusion with the WATCHMAN™ for stroke prevention in atrial fibrillation.

Atrial fibrillation (AF) is a major cause of stroke and systemic embolism. Although warfarin and the novel oral anticoagulants reduce thromboembolic risk, they are associated with an ongoing bleeding hazard, in addition to other limitations that deter their use. The left atrial appendage (LAA) appears to be the primary source of thrombus in AF; therefore, LAA closure represents a mechanical strategy for stroke prevention in these patients. The WATCHMAN™ LAA closure device (Boston Scientific, Natick, MA) is a nitinol-framed occluder that is implanted percutaneously under echocardiographic and fluoroscopic guidance. Data from two randomized clinical trials support the clinical efficacy of transcatheter LAA occlusion with the WATCHMAN and demonstrate that procedural safety has improved significantly since initial experience. This article summarizes the rationale, procedural technique, safety, and clinical efficacy of the WATCHMAN device in patients with AF at high risk for thromboembolic events.