Postapproval Community Hospital Experience in the United States with Left Atrial Appendage Closure Device (Watchman) Koroush Khalighi, MD,* , † Munish Sharma, MD,‡ Rohit Masih, MD,‡ and Vadim Levin, MD† Background: To review the procedural safety and postimplantation complications of Watchman device implanted at 2 community hospitals for primary prevention of systemic embolization in patients with nonvalvular atrial fibrillation (NVAF) who were not candidates for long-term oral anticoagulation (OAC). Methods: This was a retrospective case series of 48 patients carried out in 2 community hospitals in the United States. Patients with NVAF who had a CHADS2 higher than 2 or CHADS2VASc2 (congestive heart failure, hypertension, age ≥75 years, diabetes mel- litus, prior stroke or transient ischemic attack [TIA] or thromboembolism, vascular disease, age 65-74 years, and female gender) score of 3 or higher and were not candidates for long-term OAC. These patients were selected for implantation of Watchman device. They were followed up at 45 days, 6 months, 9 months, and 12 months after implantation of Watchman device to assess for complications involving the device and to determine if anticoagulation could be discontinued at the 45 days follow-up. They were monitored for any systemic thromboembolism while off anticoagulation. Results: The success rate of device implantation was 98% (48 of 49). Only a single patient could not get Watchman implantation because of unfavorable left atrial appendage anatomy. Access-related and device implantation-related com- plications were zero (0%). At 45 days follow-up and end of follow-up duration, the rate of thrombus formation on the Watchman device was 4% (2 of 48). One patient had TIA after warfarin discontinuation. Conclusion: With improved procedural technique and well-trained operators, Watchman implantation is feasible in a com- munity hospital also. Key Words: Nonvalvular atrial fibrillation—left atrial appendage closure device—Watchman device—stroke prevention—community hospital. © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. Background Atrial fibrillation (AF) is the most common cardiac ar- rhythmia with estimated number of individuals in 2010 being 33.5 million worldwide. 1 In the United States, the estimated prevalence of AF is about 3.03 million, with projected prevalence by 2050 to be around 7.56 million. 2 One of the most devastating complications of AF is stroke. AF increases the risk of stroke 5-fold; this risk is not ho- mogeneous and changes cumulatively with the presence of stroke risk factors. In some patients, stroke can be the first manifestation of the AF. About 30% cryptogenic strokes have silent AF. 3 Since 2010, 4 new medications have been approved by U.S. Food and Drug Administration (US-FDA) for stroke prevention in patients with nonvalvular AF (NVAF). These drugs are dabigatran, rivaroxaban, apixaban, and edoxaban. In spite of the significant advancement in the pharma- cological therapy, around 32% of patients who have indications for anticoagulation therapy based on CHADS2 and CHA2DS2VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or tran- sient ischemic attack [TIA] or thromboembolism, vascular From the *Drexel University College of Medicine, Philadelphia, Pennsylvania; †Department of Cardiology, Easton Hospital, Easton, Pennsylvania; and ‡Department of Internal Medicine, Easton Hos- pital, Easton, Pennsylvania. Received January 20, 2018; revision received May 5, 2018; accepted May 15, 2018. Address correspondence to Munish Sharma, Easton Hospital, 250 s 21 Street, Easton, PA. E-mail: munishs1@hotmail.com. 1052-3057/$ - see front matter © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.016 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2018: pp ■■–■■ 1