Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JACC Clin Electrophysiol. 2017 Dec 11;3(12):1380-1386. doi: 10.1016/j.jacep.2017.05.006. Epub 2017 Aug 2.
This study investigated characteristics and clinical impact of device-related thrombus formation after Watchman device implantation in atrial fibrillation (AF) patients.
Left atrial appendage occlusion using the Watchman device is an effective alternative to anticoagulation for stroke prevention in AF patients. However, device-related thrombus formation remains an important concern after Watchman implantation.
From 2006 to 2014, 119 consecutive AF patients underwent Watchman implantation. Transesophageal echocardiographic (TEE) follow-up was scheduled at 45 days, at 6 months, and at 12 months after the procedure. The incidence, characteristics, and clinical course of device-related thrombus formation detected by TEE were assessed.
Follow-up TEE identified thrombus formation on the Watchman device in 4 patients (3.4%). The prevalence of chronic AF was 100% in patients with thrombus, which was higher than that for patients without thrombus (40.0%). Deployed device size was numerically larger in patients with thrombus (29.3 ± 3.8 mm vs. 25.7 ± 3.2 mm, respectively). All patients with thrombus discontinued any of the anticoagulant/antiplatelet therapy which was required under the study protocol. After restarting or continuing warfarin and aspirin therapy, complete resolution of the thrombus was achieved in all patients at subsequent follow-up TEE. Warfarin therapy was discontinued within 6 months for all cases, and there was no thrombus recurrence. The mean follow-up duration was 1,456 ± 546 days, with no death, stroke, or systemic embolization events in patients with thrombus.
AF burden, device size, and anticoagulant/antiplatelet regimens can be associated with device-related thrombus after Watchman device implantation. Short-term warfarin therapy was effective, and the clinical outcomes were favorable.
本研究旨在探讨房颤（AF）患者植入 Watchman 装置后与器械相关的血栓形成的特点和临床影响。
使用 Watchman 装置进行左心耳封堵术是 AF 患者预防卒中的一种有效抗凝替代方法。然而，Watchman 植入后器械相关血栓形成仍然是一个重要的关注点。
2006 年至 2014 年，连续 119 例 AF 患者接受了 Watchman 植入术。术后 45 天、6 个月和 12 个月进行经食管超声心动图（TEE）随访。评估 TEE 检测到的器械相关血栓形成的发生率、特征和临床过程。
随访 TEE 在 4 例（3.4%）患者的 Watchman 装置上发现血栓形成。血栓形成患者的慢性 AF 患病率为 100%，高于无血栓形成患者（40.0%）。有血栓形成的患者植入的器械尺寸略大（分别为 29.3±3.8mm 和 25.7±3.2mm）。所有有血栓形成的患者均停止了研究方案要求的任何抗凝/抗血小板治疗。在随后的 TEE 随访中，所有患者均通过重新开始或继续使用华法林和阿司匹林治疗使血栓完全溶解。所有病例均在 6 个月内停用华法林治疗，且无血栓复发。平均随访时间为 1456±546 天，血栓形成患者无死亡、卒中和全身性栓塞事件发生。
AF 负荷、器械尺寸和抗凝/抗血小板方案可能与 Watchman 装置植入后器械相关血栓形成有关。短期华法林治疗有效，临床结局良好。
