Occlusion of Bilobulated Left Atrial Appendage Using the Dual-Watchman Technique: A Long-Term Follow-Up Study

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Percutaneous left atrial appendage (LAA) occlusion is an alternative to oral anticoagulation for preventing embolic events in non-valvular atrial fibrillation (NVAF).
• Complex and heterogeneous LAA anatomy, particularly large bilobulated LAA, can pose challenges for single-device occlusion.
• The efficacy of a single-device approach may be limited in certain anatomies, necessitating alternative strategies.

Purpose of the Study:

• To evaluate the feasibility and safety of a one-stop dual Watchman implantation technique.
• To assess the effectiveness of this strategy for patients with bilobulated LAA.
• To determine if this approach can achieve complete LAA closure in challenging anatomies.

Main Methods:

• Analysis of patients who underwent complete LAA closure using dual Watchman devices between December 2015 and December 2021.
• Evaluation of anatomic morphology, procedure characteristics, safety, and complications.
• Post-operative assessment of occlusion using cardiac CT or transesophageal ultrasound at specified intervals up to 2 years.

Main Results:

• Seven patients (2.1%) were treated with the one-stop dual Watchman strategy for bilobulated LAA.
• Successful occlusion was achieved in all treated patients.
• One case of pericardial effusion occurred perioperatively; no device embolization or thrombosis was observed during 2-year follow-up, with minor incomplete sealing in two cases.

Conclusions:

• One-stop dual Watchman implantation is a feasible and safe procedure for managing large, bilobulated LAA.
• This technique offers a viable strategy to achieve complete LAA occlusion when a single device may result in incomplete closure.
• The study supports the use of dual Watchman implantation in specific complex LAA anatomies.