Related Experiment Video
Updated: Dec 17, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
A simple method to detect leaks after left atrial appendage occlusion with Watchman
Hüseyin Ayhan1, Sanghamitra Mohanty2,3, Ömer Gedikli4
1Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Insights
Transesophageal echo (TEE) can identify peri-device leak (PDL) after Watchman procedures by assessing left atrial appendage (LAA) thrombus morphology. Nonwhite LAA appearance on TEE reliably indicates a significant leak, while white appearance suggests complete closure.
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.
Background:
We evaluated the efficacy of a new method in identifying peri-device leak (PDL) using morphology of the thrombus formed inside the left atrial appendage (LAA) as seen on follow-up transesophageal echo (TEE).
Method:
A total of 291 consecutive patients undergoing Watchman procedure were included in this analysis. TEE was performed at 45 days postprocedure. Based on the presence of the thrombus inside the LAA behind the device, patients were grouped as (1) white (W) group: LAA completely filled with thrombus (n = 101), 2) nonwhite (NW) group: LAA completely black or mixed (part black and part white; n = 190). Follow-up TEE was repeated at 6 and 12 months.
Results:
Baseline characteristics were comparable between groups except the device size, number of patients with chicken-wing morphology, and prevalence of left atrial "smoke" that were significantly higher in the NW group. Detection of black appearance was comparable between the pre-coil closure image and the NW population (26/36 [72.2%] vs 99/154 [64.3%], p = .37). After adjusting for clinically relevant covariates, NW appearance of the LAA was associated with the presence of significant leak (odds ratio: 47.96, 95% confidence interval: 2.91-790.2, p < .001). The 11 patients with mixed appearance at the 6-month TEE remained unchanged (part black and part white) at the 12-month TEE. LAA appearance was white in all 36 patients following coil closure.
Conclusion:
Our findings demonstrated white and nonwhite appearance of the appendage on TEE to be reliable markers of complete closure and leak respectively, following LAA occlusion with the Watchman device.
