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Updated: Jun 24, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Minimalistic approach to left atrial appendage occlusion guided by cardiac computed tomography angiography
Xian-Sai Meng1, Qing-Song Wang1, Xin-Yan Wang1
1Graduate School of Chinese PLA Medical College, Beijing, China.
Insights
This study shows that using cardiac computed tomography angiography (CCTA) for planning left atrial appendage occlusion (LAAO) is feasible and safe. This minimalistic approach reduces procedure time and hospital stay, offering a potential alternative for certain patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Left atrial appendage occlusion (LAAO) is a crucial procedure for stroke prevention in patients with atrial fibrillation.
- Traditional LAAO often relies on transesophageal echocardiography (TEE) and general anesthesia, posing limitations for some patients.
- Cardiac computed tomography angiography (CCTA) offers detailed anatomical visualization, potentially enabling alternative procedural guidance.
Purpose of the Study:
- To evaluate the feasibility and safety of a minimalistic left atrial appendage occlusion (LAAO) approach.
- To assess the efficacy of cardiac computed tomography angiography (CCTA) in guiding LAAO procedures.
- To compare outcomes of CCTA-guided LAAO with standard LAAO methods.
Main Methods:
- A retrospective analysis of 90 patients undergoing LAAO, with 30 in the CCTA-guided group (CT group) and 60 matched controls.
- The CT group utilized preprocedural CCTA for detailed procedural planning and guidance.
- Standard LAAO techniques were employed in the control group; all patients were followed for 12 months with CCTA for device surveillance.
Main Results:
- Successful Watchman device implantation was achieved in all patients across both groups.
- The CT group demonstrated significantly shorter procedure durations (45.6 ± 10.7 min vs. 58.8 ± 13.0 min) and hospital stays (7.5 ± 2.4 days vs. 9.6 ± 2.8 days).
- While the CT group had a higher radiation dose (904.9 ± 348.0 mGy vs. 711.9 ± 211.2 mGy), complication rates (pericardial effusion and 12-month adverse events) were comparable between groups.
Conclusions:
- Preprocedural CCTA planning facilitates a minimalistic LAAO approach, proving both feasible and safe.
- This CCTA-guided method offers benefits of reduced procedure time and hospital stay, with acceptable increases in radiation and contrast use.
- CCTA-guided LAAO presents a promising alternative for patients unable to undergo general anesthesia or TEE.
Objective:
To assess the feasibility and safety of the minimalistic approach to left atrial appendage occlusion (LAAO) guided by cardiac computed tomography angiography (CCTA).
Methods:
Ninety consecutive patients who underwent LAAO, with or without CCTA-guided, were matched (1:2). Each step of the LAAO procedure in the computed tomography (CT) guidance group (CT group) was directed by preprocedural CT planning. In the control group, LAAO was performed using the standard method. All patients were followed up for 12 months, and device surveillance was conducted using CCTA.
Results:
A total of 90 patients were included in the analysis, with 30 patients in the CT group and 60 matched patients in the control group. All patients were successfully implanted with Watchman devices. The mean ages for the CT group and the control group were 70.0 ± 9.4 years and 68.4 ± 11.9 years (P = 0.52), respectively. The procedure duration (45.6 ± 10.7 min vs. 58.8 ± 13.0 min, P < 0.001) and hospital stay (7.5 ± 2.4 day vs. 9.6 ± 2.8 day, P = 0.001) in the CT group was significantly shorter compared to the control group. However, the total radiation dose was higher in the CT group compared to the control group (904.9 ± 348.0 mGy vs. 711.9 ± 211.2 mGy, P = 0.002). There were no significant differences in periprocedural pericardial effusion (3.3% vs. 6.3%, P = 0.8) between the two groups. The rate of postprocedural adverse events (13.3% vs. 18.3%, P = 0.55) were comparable between both groups at 12 months follow-up.
Conclusions:
CCTA is capable of detailed LAAO procedure planning. Minimalistic LAAO with preprocedural CCTA planning was feasible and safe, with shortened procedure time and acceptable increased radiation and contras consumption. For patients with contraindications to general anesthesia and/or transesophageal echocardiography, this promising method may be an alternative to conventional LAAO.
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