# The WATCHMAN Device Is a Promising Solution for Stroke Prevention in Non-Valvular Atrial Fibrillation: Challenges and Future Directions in South and Southeast Asia

## TL;DR

The WATCHMAN device is a promising alternative to anticoagulants for stroke prevention in atrial fibrillation patients, but its adoption in South and Southeast Asia is hindered by cost and infrastructure issues.

## Contribution

The paper highlights regional challenges and proposes solutions like local manufacturing and training to improve WATCHMAN device adoption in South and Southeast Asia.

## Key findings

- High costs and limited infrastructure hinder WATCHMAN device adoption in South and Southeast Asia.
- Multicenter studies and public awareness campaigns are needed to improve access and outcomes.
- Local manufacturing and government subsidies could help increase device accessibility.

## Abstract

The WATCHMAN device (Boston Scientific Corporation, Marlborough, USA), a left atrial appendage occlusion (LAAO) device, represents a significant advancement in stroke prevention for patients with non-valvular atrial fibrillation (AFib) who are contraindicated for long-term anticoagulation therapy. By sealing the left atrial appendage (LAA), the device reduces the risk of thromboembolic events, offering an alternative to traditional anticoagulants like warfarin and direct oral anticoagulants (DOACs). Despite its proven efficacy in clinical trials, such as perforation-reducing outcomes for transcatheter endocardial closing technology (PROTECT-AF) and proactive risk evaluation validation and integrated lifecycle (PREVAIL), the adoption of the WATCHMAN device in South and Southeast Asia faces significant challenges. High procedural costs, limited healthcare infrastructure, inadequate insurance coverage, and a lack of specialized training for interventional cardiologists hinder its widespread use. Additionally, the prevalence of AFib in these regions, though lower than in Western populations, is rising, necessitating innovative solutions for stroke prevention. This article explores the barriers to WATCHMAN Device adoption in South and Southeast Asia, including cost, accessibility, and awareness, while proposing future directions such as local manufacturing, government subsidies, and enhanced training programs. Multicenter studies, public awareness campaigns, and collaboration between healthcare stakeholders are essential to improve access and outcomes. By addressing these challenges, the WATCHMAN device can play a pivotal role in reducing stroke risk and improving the quality of life for AFib patients in these regions.