P1440Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation with Watchman device versus Amplatzer Cardiac Plug. Results of the multicenter Russian trial
Abstract Background The data are limited on comparative efficacy and safety of the left atrial appendage occlusion (LAAO) using the Watchman device (WD) and Amplatzer Cardiac Plug (ACP) for stroke prevention in nonvalvular atrial fibrillation (AF) patients. Objective To assess the safety and efficacy of the WD compared with ACP for stroke prevention and adverse events in patients with AF. Methods 200 consecutive patients (median age 67.5yrs, 94 female, median CHA2DS2VASc score - 4, median HASBLED score 3) with nonvalvular AF and contraindications to oral anticoagulation therapy from 5 medical centers in Russia, who undergone LAAO implantation using WD (n = 108; WD group) and ACP (n = 92; ACP group) were enrolled into this study. The coprimary end point was the composite of TIA/stroke and procedure-related complications during follow up. Secondary end points included successful LAA occluder implantation rate and incidence rates of significant leakage. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected. Results During the follow-up TIA/stroke has occurred in 6.2% of patients in the WD group with no such events in ACP group (6.2% vs 0%, p = 0.012). The composite safety-efficacy survival rate in WD group was 91.7% versus 92.4% in ACP group (p = 0.85). The periprocedural major complications rate (pulmonary trunk perforation with fatal haemotamponade, nonfatal haemotamponade with pericardiocentesis, device embolisation) was significantly higher in ACP group compared with WD group (5.4% vs 0%, p = 0.005). There was no significant difference in overall events rate between groups (3.7% vs 7.6%, p = 0.2). Successful LAA occluder implantation was performed in all 92 (100%) patients with ACP and in 105 (97,2%) with WD (p = 0.053). The significant leakage (≥5mm) was 3.03% in WD group with no such events in ACP group (3.03% vs 0%, p = 0.059). Conclusion LAAO using ACP was associated with higher major procedure-related complications rate. Despite a higher TIA/stroke rate in WD group, the composite efficacy and safety survival rate of LAAO using the WD and ACP was comparable during 12 month follow up.