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Watchman Occlusion in Long-Standing Persistent Atrial Fibrillation: Larger Left Atrial Appendages With Greater

Matthew S Glassy1, William Wung1, Sarah Westcott1

  • 1Division of Cardiovascular Medicine, University of California, Davis, Davis, California.

JACC. Cardiovascular Interventions
|June 8, 2019
PubMed

Insights

Patients with long-standing persistent atrial fibrillation (LSPAF) have larger left atrial appendage (LAA) sizes, requiring larger Watchman devices and experiencing more residual leaks post-procedure. LSPAF patients may need closer follow-up.

Area of Science:

  • Cardiology
  • Medical Devices
  • Echocardiography

Background:

  • Atrial fibrillation (AF) burden correlates with left atrial (LA) remodeling and enlargement.
  • Long-standing persistent atrial fibrillation (LSPAF) may influence anatomical characteristics relevant to LAA occlusion.
  • Understanding anatomical differences is crucial for optimizing Watchman device implantation.

Purpose of the Study:

  • To compare anatomical measurements and procedural outcomes in patients with and without LSPAF undergoing Watchman LAA occlusion.
  • To evaluate the impact of LSPAF on LAA dimensions, device selection, and post-procedure residual leak.
  • To identify potential risk stratification factors for Watchman procedures based on AF history.

Main Methods:

  • Retrospective analysis of 101 consecutive Watchman LAA occlusion cases.
  • Patients categorized into LSPAF (n=48) and non-LSPAF (n=53) groups.
  • Transesophageal echocardiography (TEE) used to measure LAA ostial diameter, depth, device compression, and residual leak.

Main Results:

  • LSPAF patients exhibited significantly larger LAA ostial diameters and depths across multiple TEE views compared to non-LSPAF patients (p<0.0001).
  • A higher proportion of LSPAF patients received larger Watchman devices (77% vs. 46%, p=0.003).
  • While initial leak rates were similar, LSPAF patients had a higher incidence of moderate residual leaks at 6-week follow-up TEE (27% vs. 4%, p=0.04).

Conclusions:

  • Patients with LSPAF demonstrate significantly larger LAA dimensions, necessitating larger implant devices.
  • LSPAF is associated with an increased risk of moderate residual LAA leaks post-Watchman implantation.
  • LSPAF may indicate a higher-risk patient group requiring more intensive follow-up after LAA occlusion.
Abstract

Keywords:
Watchman deviceleft atrial appendage occlusionlong-standing persistent atrial fibrillationperidevice leak

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