A simple method to detect leaks after left atrial appendage occlusion with Watchman

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Peri-device leak (PDL) is a complication after left atrial appendage (LAA) occlusion.
• Accurate identification of PDL is crucial for patient management.
• Transesophageal echo (TEE) is a key imaging modality for assessing LAA occlusion outcomes.

Purpose of the Study:

• To evaluate the efficacy of a novel method for identifying PDL.
• To utilize thrombus morphology within the LAA on follow-up TEE as a diagnostic marker.
• To correlate LAA thrombus appearance with the presence or absence of PDL.

Main Methods:

• Analysis of 291 patients undergoing Watchman procedures.
• Follow-up TEE performed at 45 days postprocedure.
• Patients grouped into 'white' (complete thrombus) and 'nonwhite' (partial/no thrombus) LAA appearance groups.

Main Results:

• Nonwhite LAA appearance was significantly associated with the presence of significant leak (OR: 47.96, p < .001).
• Baseline characteristics were comparable, with some differences in device size and atrial morphology.
• Mixed LAA appearance persisted over time, while white appearance indicated closure.

Conclusions:

• White and nonwhite LAA appearance on TEE are reliable markers for complete closure and leak, respectively.
• This morphological assessment aids in identifying PDL post-LAA occlusion.
• TEE-based thrombus morphology offers a valuable tool for Watchman procedure follow-up.