[Implantation of Watchman™ occluder of the left atrial appendage. Tips and tricks]

The implantation of an occluder system for the left atrial appendage (LAA) represents an interesting alternative for patients with atrial fibrillation and a CHA2DS2-VASc-Score ≥ 2 who cannot take permanent anticoagulation for various reasons. As in other left cardiac interventions, there are potentially dangerous possibilities for complications that can limit the advantages of this therapy. This overview summarizes practical tips and tricks at the implantation of a Watchman™ occluder which may help to minimize the complication rate. These hints refer to peri-interventional anticoagulation as well as transseptal puncture (technique, imaging), exchange of catheters, left atrial pressure, intubation and fluoroscopy of the LAA, preparation of the device and sheath, delivery of the Watchman™ device, confirmation of optimal position, and partial or complete recapture. If these precautions are considered, the complication rate at implantation of a Watchman™ occluder should be < 5 %, the rate of complications with long-term consequences < 1 %, and the implant success should lie > 95 %.