Abstract 11705: Events of Device Failure in Elderly Patients Undergoing Watchman Device Insertion in the United States
Jasninder Dhaliwal, Rahat A Memon, Shruti Aggarwal, Kamleshun Ramphul, Shaheen Sombans, Hemamalini Sakthivel- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Watchman device implant reduces various cardio-cerebral events in patients with left atrial appendage. As there is a lack of data on device failure among the elderly undergoing this procedure, we aim to provide a perspective via the 2016-2020 National Inpatient Sample(NIS).
Methods: Watchman procedures in patients ages ≥60 years, with a history of atrial fibrillation or flutter, were examined for our study from the NIS. Events of device failure were considered, and variables that may influence such events were studied via logistic regression models.
Results: We found 85190 procedures for Watchman device insertion conducted in the United States, and 510 (0.6%) cases reported an event of device failure. Procedures at rural centers reported higher odds of device failure than urban teaching centers (1.3% of rural center procedures vs. 0.6% of urban teaching hospital procedures, aOR 2.970, 95% CI 1.965 -4.488, p<0.01). Meanwhile, patients with a history of CKD (aOR 0.565, p<0.01), hypertension (aOR 0.500, p<0.01), and peripheral vascular diseases (aOR 0.513, p=0.012) showed reduced odds. Several complications were also noted among those with device failure, as 20 cases (3.9% ) had acute kidney injury, 45 patients (8.8%) developed cardiac tamponade, 70 cases (13.7%) had pericardial effusion, and 20 cases (3.9%) necessitated mechanical ventilation. The mean CHA 2 DS 2 -VASc score among patients with device failure was 4.65 (vs. 4.68, p=0.029), and the mean Charlson Comorbidity Index score was 1.42 (vs 1.65, p<0.01). Patients with device failure had a more expensive stay (mean hospital charge $144936 vs. $122504).
Conclusions: Device failure was a rare but severe complication involving 0.6% of procedures in our analysis. Many comorbidities influenced events of device failure. As our study found a higher incidence among procedures done in rural centers, further studies to screen and assess the patients and monitor their condition may help improve the outcomes.