Management with the Watchman device in a patient with atrial fibrillation and on dialysis therapy. Case report and narrative review
PDF (Español)
HTML (Español)


atrial fibrillation;
peritoneal dialysis;
chronic kidney disease;
atrial appendage (MeSH).

How to Cite

Rosselli Sanmartín C, Torres Serrano RE, Olivares Algarin O, Olivares Algarin CR, Eslava Orozco DF, Núñez Pinilla ER, Pérez Morales HE. Management with the Watchman device in a patient with atrial fibrillation and on dialysis therapy. Case report and narrative review. Rev. Colomb. Nefrol. [Internet]. 2020 Aug. 10 [cited 2024 Jul. 25];7(2). Available from:


Anticoagulation remains the therapy of choice for the majority of patients with non-valvular atrial fibrillation, however, in patients with chronic kidney disease at high risk of bleeding, local antithrombotic therapies such as the left atrial closure with Watchman device should be considered. We report the first case of implant of this type device in the Hospital de San José at the City of Bogotá, Colombia, and a narrative review ofthe literature is made. Watchman’s use is associated with fewer hemorrhagic strokes(0.15 versus 0.96 events/ 100 patients-year HR: 0.22; p = 0.004), cardiovascular death / unexplained death (1.1 vs. 2.3 events/ 100 patient-year; HR: 0.48; p = 0.006), and bleeding not associated with the procedure (6.0 % vs. 11.3 %; HR: 0.51; p = 0.006) compared to warfarin. Key words: atrial fibrillation, dialysis, peritoneal dialysis, chronic kidney disease, atrial appendage (MeSH).
PDF (Español)
HTML (Español)


Pava-Molano LF, Perafán-Bautista PE. Generalidades de la fibrilación auricular. Rev Colomb Cardiol. 2016;23(Suppl 5):5-8.

Cottrell C. Atrial fibrillation part 1: pathophysiology. Practice Nursing. 2012;23(1):16-21.

Agewall S, Camm J, Barón-Esquivias G, Budts W, Carerj S, Casselman F, et al. Guía ESC 2016 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración con la EACTS. Revista Española de Cardiología. 2017;70(1):50.e1-84.

Zimmerman D, Sood MM, Rigatto C, Holden RM, Hiremath S, Clase CM. Systematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis. Nephrol Dial Transplant. 2012;27(10):3816-22.

Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374(9689):534-42.

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-47.

Rosselli D, Rodríguez AJ, García ÁA, Rueda JD. Prevalencia de fibrilación auricular en un hospital universitario colombiano. Rev. Colomb. Cardiol. 2013;20(6):383-5.

Sposato LA, Cipriano LE, Saposnik G, Ruíz-Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-87.

Werth S, Breslin T, NiAinle F, Beyer-Westendorf J. Bleeding Risk, Management and Outcome in Patients Receiving Non-VKA Oral Anticoagulants (NOACs). Am J Cardiovasc Drugs. 2015;15(4):235-42.

Yao X, Abraham NS, Alexander GC, Crown W, Montori VM, Sangaralingham LR, et al. Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation. J Am Heart Assoc. 2016;5(2):e003074.

Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke. 2009;40(1):235-40.

Chan KE, Lazarus JM, Thadhani R, Hakim RM. Warfarin use associates with increased risk for stroke in hemodialysis patients with atrial fibrillation. J Am Soc Nephrol. 2009;20(10):2223-33.

Winkelmayer WC, Liu J, Setoguchi S, Choudhry NK. Effectiveness and safety of warfarin initiation in older hemodialysis patients with incident atrial fibrillation. Clin J Am Soc Nephrol. 2011;6(11):2662-8.

Olesen JB, Lip GY, Kamper AL, Hommel K, Køber L, Lane DA, et al. Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med. 2012;367(7):625-35.

Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, et al. Outcomes Associated With Apixaban Use in Patients With EndStage Kidney Disease and Atrial Fibrillation in the United States. Circulation. 2018;138(15):1519-29.

Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755-9.

Merella P, Lorenzoni G, Delitala AP, Sechi F, Decandia F, Viola G, et al. Left Atrial Appendage Occlusion in High Bleeding Risk Patients. J Interv Cardiol. 2019;18:6704031.

Holmes DR, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64(1):1-12.

Holmes DR, Doshi SK, Kar S, Price MJ, Sanchez JM, Sievert H, et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis. J Am Coll Cardiol. 2015;65(24):2614-23.

Reddy VY, Gibson DN, Kar S, O’Neill W, Doshi SK, Horton RP, et al. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol. 2017;69(3):253-61.

Price MJ, Reddy VY, Valderrábano M, Halperin JL, Gibson DN, Gordon N, et al. Bleeding outcomes after left atrial appendage closure compared with long-term warfarin: a pooled, patient-level analysis of the WATCHMAN randomized trial experience. JACC: Cardiovasc Interv. 2015;8(15):1925-32.

Afzal MR, Daoud EG. EWOLUTION-The next evolution in appendage closure? Heart Rhythm. 2017;14(9):1309-10.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2020 Revista Colombiana de Nefrología




Download data is not yet available.