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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Percutaneous Left Atrial Appendage Closure Using an Occluder Device: A Single Center Experience
Isaiah C Lugtu1,2, Wen-Han Cheng1,3, Shih-Lin Chang1,3
1Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Percutaneous left atrial appendage (LAA) closure is a feasible stroke risk reduction strategy for atrial fibrillation patients, particularly those with bleeding risks. The procedure demonstrated a low rate of major complications, though residual LAA contrast leak was observed in some cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- The left atrial appendage (LAA) is a primary source of thrombus formation in patients with atrial fibrillation.
- Occlusion of the LAA can significantly reduce the risk of stroke in these patients.
Purpose of the Study:
- To assess the feasibility, safety, and outcomes of percutaneous LAA closure using an occluder device.
- To evaluate residual LAA contrast leak on CT imaging after LAA occlusion implantation.
Main Methods:
- Retrospective analysis of consecutive patients undergoing percutaneous LAA occlusion (LAAO) at Taipei Veterans General Hospital.
- Inclusion of 23 patients with a median age of 67 years and a median CHA2DS2-VASc score of 4.
- Assessment of procedural success, complications, and post-implantation CT findings for residual contrast leak.
Main Results:
- Successful device implantation was achieved in 95.7% of patients.
- No deaths, strokes, device embolizations, or major bleeding events occurred.
- Minor complications included cardiac tamponade (1), intra-procedural thrombus (1), mitral valve leaflet impingement (1), and device-related thrombosis (1).
- Residual contrast leak into the LAA was detected in 6 of 12 patients (50%) who underwent post-implantation CT scans.
Conclusions:
- Percutaneous LAA occlusion is a feasible procedure with a low risk of major complications.
- Further investigation into managing residual LAA contrast leak is warranted.
Background:
Left atrial appendage (LAA) is the main source of thrombus formation, and occlusion of this structure decreases the risk of stroke in patients with atrial fibrillation.
Objectives:
We aimed to describe the feasibility, safety and outcomes of percutaneous LAA closure using an occluder device, and to evaluate residual LAA contrast leak detected on computed tomography (CT) imaging in patients who underwent implantation in our institution.
Methods:
Consecutive patients of Taipei Veterans General Hospital who underwent percutaneous implantation of an LAA occluder (LAAO) were retrospectively collected and analyzed.
Results:
A total of 23 patients were included with a median age of 67 years (42-87) and median CHA2DS2-VASc score of 4 (1-7). The most frequent indication for intervention was bleeding while on oral anticoagulation treatment. After a mean follow-up of 31.17 ± 25.10 months, successful device implantation was achieved in 95.7% of the patients. There was no occurrence of death, stroke, device embolization, acute ST elevation myocardial infarction, major bleeding requiring invasive treatment or blood transfusion, inguinal hematoma or major bleeding related to antiplatelet therapy. One patient had cardiac tamponade, 1 had intra-procedural thrombus formation, 1 had impingement of mitral valve leaflet, and 1 had device-related thrombosis. Of 12 patients who underwent CT post- implantation, 6 had residual contrast leak into the LAA, one third of those who had peri-device leak.
Conclusions:
Percutaneous implantation of an LAAO appeared to be feasible with a low risk of major complications.
