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Type: Journal article
Title: Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry
Author: Phillips, K.
Santoso, T.
Sanders, P.
Alison, J.
Chan, J.
Pak, H.
Chandavimol, M.
Stein, K.
Gordon, N.
Razali, O.
Citation: International Journal of Cardiology: Heart and Vasculature, 2019; 23:100358-1-100358-6
Publisher: Elsevier
Issue Date: 2019
ISSN: 2352-9067
Statement of
Karen P. Phillips, Teguh Santoso, Prashanthan Sanders, Jeffrey Alison, Jason Leung Kwai Chan, Hui-Nam Pak, Mann Chandavimol, Kenneth M. Stein, Nicole Gordon, Omar Bin Razali
Abstract: Background: 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. Methods: 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. Results: Subjects (n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA2DS2-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]). Conclusion: Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort.
Keywords: Atrial fibrillation; ischaemic stroke; left atrial appendage; LAA device closure; anticoagulant therapy
Rights: © 2019 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (
DOI: 10.1016/j.ijcha.2019.100358
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