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Updated: Aug 1, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Utilization of WATCHMAN FLX for surgically incomplete left atrial appendage occlusion: a multicentre case series
Hafez Golzarian1, Alaha Mariam1, Sidra R Shah1
1BonSecours Mercy Health-St. Rita's Medical Center, Internal Medicine Residency Program, 751 West Market Street, Lima, OH 4580, USA.
Insights
Surgical left atrial appendage occlusion (LAAO) can fail, leaving residual lobes that risk stroke. Percutaneous LAAO using the WATCHMAN FLX device offers a safe solution to completely seal these residual LAAO failures, reducing stroke risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) patients often develop thrombi in the left atrial appendage (LAA), increasing stroke risk.
- Surgical left atrial appendage occlusion (LAAO) aims to prevent stroke but can result in incomplete closure, leaving residual LAA lobes.
- Limited data exists on using percutaneous devices for residual LAAO after surgical failure.
Observation:
- Three cases of patients with residual LAA after prior surgical LAAO were identified.
- These patients remained at high risk for ischemic stroke due to incomplete surgical closure.
- Percutaneous LAAO with the WATCHMAN FLX device was performed on these patients.
Findings:
- The WATCHMAN FLX device successfully achieved complete sealing of residual LAA lobes in all three cases.
- This percutaneous approach provided a solution for previously failed surgical LAAO.
- No immediate complications were reported following the WATCHMAN FLX implantation.
Implications:
- Incomplete surgical LAAO is a clinical reality, posing ongoing stroke risk.
- The WATCHMAN FLX device presents a feasible and safe option to supplement incomplete surgical LAAO.
- This approach may significantly reduce the risk of ischemic stroke and systemic embolization in select patients.
Background:
In patients with non-valvular atrial fibrillation, the vast majority of thrombi originate in the left atrial appendage (LAA). Thus, occluding the LAA significantly reduces one's risk for developing an ischaemic stroke. To date, many different surgical methodologies in LAA occlusion (LAAO)/exclusion have been studied and utilized. Unfortunately, patients are often left with incomplete closure of their LAA, leaving behind residual lobes that continue to allow thrombus formations. With the recent rise in percutaneous approaches and devices such as the WATCHMAN FLX, there have been proven success rates in achieving total closure of the LAA. Reports and investigations regarding the utilization of WATCHMAN FLX devices in patients with surgically incomplete LAAO remain limited.
Case Summary:
We present three cases of patients who had previously undergone surgical exclusion of the LAA yet unfortunately were left with residual LAA that continued to place them at high risk for an ischaemic stroke. Percutaneous LAAO with the WATCHMAN FLX was utilized to successfully achieve complete sealing of the residual lobes in failed LAA surgical closures.
Discussion:
Our multicentre case series elucidates that an increased risk of stroke due to surgical LAAO failure is a real-world possibility that is likely to be encountered in clinical practice. We demonstrate in this series how the WATCHMAN FLX may provide a feasible and safe method to supplement a surgically incomplete LAAO to allow for improved ischaemic stroke and systemic embolization risk reduction.
