Related Experiment Video
Updated: Jul 17, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy
Zhong-Bao Ruan1, Wei Li1, Kai Jin1
1Department of Cardiology, The affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, P.R. China.
Insights
Minimal left atrial appendage occlusion (LAAO) using fluoroscopy alone is a safe and feasible alternative to standard LAAO, reducing procedure time and hospital stay without compromising successful implantation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for preventing embolic stroke in nonvalvular atrial fibrillation (NVAF).
- Standard LAAO often requires transesophageal echocardiography (TEE) and general anesthesia, posing risks like esophageal injury.
Purpose of the Study:
- To evaluate the feasibility and safety of minimal LAAO (MLAAO) using the Watchman device guided solely by fluoroscopy.
- To compare MLAAO with standard LAAO (SLAAO) in patients with NVAF.
Main Methods:
- A comparative study of 249 NVAF patients undergoing LAAO with Watchman, divided into SLAAO and MLAAO groups.
- Procedural characteristics, including fluoroscopy time, radiation dose, contrast usage, procedure time, and hospitalization duration, were analyzed.
- Follow-up assessed device implantation success, occluder compression ratio, and adverse events like injury, hypotension, and dysphagia.
Main Results:
- Successful device implantation rates were similar between MLAAO and SLAAO groups.
- MLAAO showed higher fluoroscopy time, radiation dose, and contrast usage but significantly shorter procedure times and hospitalization durations.
- MLAAO was associated with fewer instances of oropharyngeal/esophageal injury, hypotension, and dysphagia compared to SLAAO.
Conclusions:
- Minimal LAAO guided by fluoroscopy alone is a safe, effective, and feasible alternative to TEE-guided procedures.
- This approach simplifies operations and is particularly beneficial for patients unable or unwilling to undergo TEE or general anesthesia.
Background:
Left atrial appendage occlusion (LAAO) has been considered an alternative treatment to prevent embolic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it carries a risk of general anesthesia or esophageal injury if guided by transesophageal echocardiography (TEE).
Aims:
We aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF.
Methods:
A total of 249 consecutive patients with NVAF who underwent LAAO using the WATCHMAN device were divided into two groups: the Standard LAAO (SLAAO) group and the MLAAO group. Procedural characteristics and follow-up results were compared between the two groups.
Results:
There was no statistically significant difference in the rate of successful device implantation (p > 0.05). Fluoroscopy time, radiation exposure dose, and contrast medium usage in the MLAAO group were higher than those in the SLAAO group (p < 0.001). The procedure time and hospitalization duration were significantly lower in the MLAAO group than those in the SLAAO group (p < 0.001). The occluder compression ratio, measured with fluoroscopy, was lower than that measured with TEE (17.63 ± 3.75% vs. 21.69 ± 4.26%, p < 0.001). Significant differences were observed between the SLAAO group and the MLAAO group (p < 0.05) in terms of oropharyngeal/esophageal injury, hypotension, and dysphagia. At 3 months after LAAO, the MLAAO group had a higher incidence of residual flow within 1-5 mm compared to the SLAAO group, although the difference was not statistically significant.
Conclusion:
MLAAO guided by fluoroscopy, instead of TEE, without general anesthesia simplifies the operational process and may be considered safe, effective, and feasible, especially for individuals who are unable to tolerate or unwilling to undergo TEE or general anesthesia.
