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Updated: Jul 4, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
The use of percutaneous left atrial appendage occluder device in a patient with prior surgical ligation with
Raef Fadel1, Essaq Khan1, Waddah Maskoun1
1Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA.
Insights
Percutaneous left atrial appendage occlusion (LAAO) device implantation is a viable option for patients with atrial fibrillation (AF) and prior surgical LAA occlusion with residual leak. This minimally invasive approach may allow for de-escalation of anticoagulation therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) is a common arrhythmia, often leading to cardioembolic stroke due to thrombus formation in the left atrial appendage (LAA).
- Surgical LAA occlusion (LAAO) and percutaneous LAA closure devices are therapeutic options, but complete LAA exclusion is not always achieved, risking persistent thrombus formation.
- Percutaneous device use in surgically occluded LAA with residual leak is less studied than in native LAA.
Observation:
- A case report details a 79-year-old female patient with a history of surgical LAAO and a residual peri-device leak (PDL).
- A 27 mm percutaneous LAAO device (WATCHMAN) was successfully deployed in the surgically ligated LAA, meeting all P.A.S.S. criteria with a minimal PDL of 1.4 mm.
- Post-procedure transesophageal echocardiogram confirmed a trivial PDL (1.49 mm) at 6 weeks.
Findings:
- Successful percutaneous LAAO device implantation in a previously surgically occluded LAA with residual leak.
- The procedure achieved satisfactory closure, with minimal residual leak, and allowed for de-escalation of anticoagulation therapy (discontinuation of apixaban).
- The P.A.S.S. (Position, Anchor, Size, and Seal) criteria were met, indicating a technically successful intervention.
Implications:
- Percutaneous LAAO device implantation offers a minimally invasive strategy for patients with AF and prior surgical LAAO with incomplete exclusion.
- This approach may be suitable for high-bleeding-risk patients, potentially enabling reduced reliance on long-term anticoagulation.
- Further studies are warranted to evaluate the long-term efficacy and safety of percutaneous LAA closure in patients with prior surgical LAA occlusion.
Background:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and the most common cause of cardioembolic stroke. The left atrial appendage (LAA) is the main source of thrombus formation in patients with AF. Therapies include use of percutaneous LAA closure devices, or surgical LAA occlusion (LAAO). Despite these options, complete closure of the LAA is not always achieved, and residual communication between the LAA and atrium may result in increased thrombus formation. Although studies have analysed the use of percutaneous measures such as coils, plugs, or second occluder device deployment in LAA with peri-device leak (PDL), use of percutaneous occlude devices in surgically occluded LAA is far less studied.
Case Summary:
We present a case of a 79-year-old female patient who underwent LAAO device deployment within a surgically occluded LAA with PDL. She underwent 27 mm LAAO device (WATCHMANTM) deployment and all the P.A.S.S. (Position, Anchor, Size, and Seal) criteria were satisfied. Only 1.4 mm PDL was present. She was continued on apixaban and aspirin post-operatively. Post-operative transoesophageal echocardiogram at 6 weeks demonstrated trivial PDL measuring 1.49 mm. Patient was continued on aspirin and clopidogrel, with discontinuation of apixaban.
Discussion:
Percutaneous LAAO device deployment in previously surgically ligated LAA with incomplete exclusion is a potential therapeutic option for patients with AF and a high bleeding risk seeking a minimally invasive strategy, in an attempt to de-escalate anticoagulation therapy.
