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Updated: May 6, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
What characterizes device-related thrombosis following LAAC, if ejection fraction fails to shine?
Peter L M Kerkhof1, Elena Osto2,3, Neal Handly4
1Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Insights
Sex differences impact cardiac chamber size, even in atrial fibrillation (AF). Understanding these variations is crucial for evaluating treatments like left atrial appendage closure and interpreting cardiac function metrics such as ejection fraction (EF).
Area of Science:
- Cardiology
- Medical Imaging
- Sex-Based Medicine
Background:
- Cardiac chamber size exhibits sex-specific variations, with smaller volumes typically observed in women compared to men.
- Heart diseases, such as atrial fibrillation (AF), can lead to chamber dilation, affecting both left atrial (LA) and left ventricular (LV) sizes.
- Sex-specific differences in chamber volumes persist even in disease states, highlighting the need for stratified analysis.
Purpose of the Study:
- To conduct a sex-stratified analysis of left ventricular ejection fraction (LVEF) and left atrial ejection fraction (LAEF) in patients with AF.
- To compare these metrics in AF patients undergoing left atrial appendage closure, with or without device-related thrombosis.
- To present an alternative analysis using primary data, emphasizing its advantages.
Main Methods:
- Sex-stratified analysis of LVEF and LAEF in AF patients.
- Comparison of cardiac function metrics between AF patients with and without device-related thrombosis after LA appendage closure.
- Exploration of an alternative primary data analysis approach.
Main Results:
- Sex-specific differences in cardiac chamber volumes and ejection fraction are observed in AF patients.
- Left atrial appendage closure outcomes may vary based on sex and the presence of device-related thrombosis.
- The study advocates for the use of age- and sex-specific reference values for LA and LV quantification.
Conclusions:
- Accurate quantification of cardiac chamber volumes, considering sex-specific differences, is essential for evaluating disease severity and treatment efficacy in AF.
- Sex-stratified analysis provides a more nuanced understanding of cardiac function in AF patients.
- Applying established age- and sex-specific reference values is critical for interpreting cardiac imaging data in LA and LV assessment.
Abstract:
Cardiac compartmental size depends on sex, with smaller values found in (healthy) women compared to a matched group of men. Various types of heart disease may cause dilation of the affected chamber. For example, atrial fibrillation (AF) is associated with enlarged left atrial (LA) size, often also implying increased left ventricular (LV) size. Sex-specific differences appear to persist during disease states. Thus, chamber volumes depend on both sex and the severity of the underlying disorder, and require quantification to evaluate the effect of interventions. Often, we rely on the popular performance metric ejection fraction (EF) which refers to the ratio of the minimum and maximum LV or LA volumetric values observed during the cardiac cycle. Here we discuss a sex stratified analysis of LVEF and LAEF in AF patients as treated by LA appendage closure, while comparing those with or without device-related thrombosis. Also, an alternative analysis based on primary data is presented while emphasizing its attractiveness. In any event, age- and sex-specific reference values as broadly documented for various imaging modalities should be applied to LA and LV.
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