INTRODUCTION:
Atrial fibrillation (AF) is the most commonly encountered sustained cardiac arrhythmia in clinical practice and responsible for more than 20% of all embolic strokes (1,2). AF-associated strokes tend to have worse morbidity and mortality when compared to strokes not related to AF (3,4). The left atrial appendage (LAA) is the location for thrombus formation in more than 90% of patients with non-valvular AF (5). Coumadin and direct oral anti-coagulants (DOACs) are the gold-standard therapy for reducing stroke risk in AF patients with risk factors for stroke. However, their utilization is often limited by lack of patient compliance and adverse effects (6,7,8). Left atrial appendage occlusion (LAAO) using an endocardial Watchman device has shown promising results in mitigating stroke risk when utilized in selected AF patients (9). The landmark PROTECT (Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) trial showed the Watchman device to be non-inferior to coumadin in terms of the primary efficacy end-point of stroke, systemic embolism and cardiovascular/unexplained death (10). Subsequently, the PREVAIL (Prospective randomized evaluation of the Watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy) trial confirmed these results and also showed a reduced rate of short-term complications (11). The results of these two trials eventually led to Food and Drug Administration (FDA) approval of the Watchman device in March of 2015. Since FDA approval of the Watchman device, there has been limited real-world data on trends in utilization, complications and in-hospital mortality from the procedure in contemporary practice. The aim of the present study is to assess these parameters from a comprehensive, national United States (US) population database.