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Updated: Jul 12, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Intra-Cardiac versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion with a Watchman
Luigi Emilio Pastormerlo1, Claudio Tondo2, Gaetano Fassini2
1Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy.
Insights
Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) show similar success rates for Watchman FLX left atrial appendage occlusion (LAAO). ICE guidance is a viable alternative to TEE for LAAO procedures.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) are imaging modalities used to guide LAAO procedures.
- The Watchman FLX device is a commonly used device for LAAO.
Purpose of the Study:
- To compare the peri-procedural success and complication rates of ICE-guided versus TEE-guided LAAO procedures using the Watchman FLX device.
- To evaluate one-year stroke and major bleeding rates between the two guidance methods.
Main Methods:
- A retrospective analysis of 772 LAAO procedures performed at 26 Italian centers.
- Procedures were guided by either ICE (149 patients) or TEE (623 patients).
- Technical and procedural success, procedural time, hospital stay, and one-year clinical outcomes (stroke, major bleeding) were compared.
Main Results:
- Technical success was 100% in both groups.
- Procedural success was high and comparable (98.7% for ICE vs. 98.5% for TEE).
- ICE was associated with longer procedural time but shorter hospital stay; one-year stroke and major bleeding rates were similar between groups.
Conclusions:
- The Watchman FLX device demonstrates high technical and procedural success rates in LAAO.
- ICE guidance is a safe and effective alternative to TEE guidance for LAAO, with comparable outcomes.
- ICE guidance may offer benefits such as a shorter hospital stay.
Abstract:
This study aimed to compare the peri-procedural success and complication rate within a large registry of intra-cardiac echocardiography (ICE)- vs. transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) procedures with a Watchmann FLX device. Data from 772 LAAO procedures, performed at 26 Italian centers, were reviewed. Technical success was considered as the final implant of a Watchmann FLX device in LAA; the absence of pericardial tamponade, peri-procedural stroke and/or systemic embolism, major bleeding and device embolization during the procedure was defined as a procedural success. One-year stroke and major bleeding rates were evaluated as outcome. ICE-guided LAA occlusion was performed in 149 patients, while TEE was used in 623 patients. Baseline characteristics were similar between the ICE and TEE groups. The technical success was 100% in both groups. Procedural success was also extremely high (98.5%), and was comparable between ICE (98.7%) and TEE (98.5%). ICE was associated with a slightly longer procedural time (73 ± 31 vs. 61.9 ± 36 min, p = 0.042) and shorter hospital stay (5.3 ± 4 vs. 5.8 ± 6 days, p = 0.028) compared to the TEE group. At one year, stroke and major bleeding rates did not differ between the ICE and TEE groups. A Watchmann FLX device showed high technical and procedural success rate, and ICE guidance does not appear inferior to TEE.
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