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A novel clock-face method for characterizing peridevice leaks after left atrial appendage occlusion
Sarah K Westcott1, William Wung1, Matthew Glassy1
1Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
Summary
Post-Watchman device implant leaks in atrial fibrillation patients commonly occur in the posterior left atrial appendage ostium. This study introduces a clock-face mapping method to describe these leak locations for better characterization.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Left atrial appendage (LAA) occlusion using the Watchman device (WD) is a key therapy for reducing thromboembolic events in atrial fibrillation (AF) patients.
- Post-implantation leaks are known complications of WD, but their precise locations and characteristics remain poorly understood.
Purpose of the Study:
- To introduce a novel clock-face mapping system for precisely localizing and quantifying leaks at the LAA ostium after WD implantation.
- To analyze the frequency and distribution of post-implant leaks in relation to the LAA anatomy.
Main Methods:
- Retrospective review of 101 consecutive WD implants.
- Transesophageal echocardiograms at 6-week follow-up were used to identify and map leak locations to a standardized clock-face representation of the LAA ostium.
- Analysis of patient demographics, LAA dimensions, and procedural characteristics.
Main Results:
- Of 34 patients with leaks, 45 leaks were detected at 6 weeks; no leaks were present at implant.
- Mean leak size was 2.67 mm, with the largest measuring 4.60 mm.
- The majority of leaks (39/45) were located in the posterior segment (6:00-12:00) of the LAA ostium.
Conclusions:
- Post-Watchman device implant leaks predominantly localize to the posterior aspect of the left atrial appendage ostium.
- The proposed clock-face mapping method offers a standardized approach for leak characterization.
- Potential contributing factors include LAA orifice shape, tissue properties, and implantation technique.
