ABSTRACT
Background: Based on the PROTECT AF and PREVAIL trials, transesophageal echocardiogram (TEE) is typically performed 45 days after WATCHMAN (Boston Scientific, DE) implantation to rule out device-related thrombus (DRT) or peri-device leak (PDL) before stopping oral anticoagulation (OAC). The utility of imaging before discontinuing OAC is uncertain. During the COVID-19 pandemic, when elective TEEs were cancelled or delayed, many patients were taken off OAC without imaging. Method(s): Patients undergoing WATCHMAN implant followed by short-term OAC from January 2018 to June 2022 at a university hospital were analyzed retrospectively. Patients who did not have imaging performed at 45 days (+/-7 days) after WATCHMAN implantation were compared with those who did. Outcomes included 1) a composite of ischemic stroke and transient ischemic attack (TIA), 2) a composite of DRT or PDL >=5 mm in patients who had 45-day imaging, and 3) a composite of DRT or PDL >=5 mm in patients who were taken off OAC at 45 days without imaging but underwent delayed imaging (within 1 year of WATCHMAN implantation). Result(s): 258 patients were followed for 1 year. 232 patients (89.9%) had TEE or cardiac computed tomography (CT) at 45 days (Figure). 3 had DRT (1.3%), which was treated successfully with 90 days of anticoagulation, and none had PDL >=5 mm. There were 4 ischemic strokes and 2 TIAs during the follow up period (2.6%), none of which were preceded by DRT. 26 patients (10.1%) were taken off OAC at 45 days without imaging. No stroke or TIA occurred in this group. No DRT or PDL >=5 mm was seen in the 15 of these 26 (58%) patients who underwent delayed imaging. Conclusion(s): A primary strategy of 45-day post-WATCHMAN imaging is still indicated, given a ~1% DRT rate, however the risk associated with discontinuing anticoagulation without imaging is low in cases where 45-day imaging is not possible. [Formula presented]Copyright © 2023