Transjugular Access for Left Atrial Appendage Closure

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Percutaneous left atrial appendage closure (LAAC) is a key stroke prevention strategy for atrial fibrillation patients.
• Transfemoral access is the standard route for LAAC.
• Certain anatomical limitations can preclude transfemoral access.

Observation:

• Two patients with atrial fibrillation and contraindications to anticoagulation presented with venous anatomy precluding transfemoral LAAC.
• Right internal jugular venous access was utilized for trans-septal puncture in both cases.
• Specialized steerable sheaths and wire techniques facilitated optimal trajectory for device implantation.

Findings:

• Successful implantation of the Watchman FLX Pro device was achieved in both patients via the transjugular route.
• No periprocedural complications were observed.
• Follow-up imaging confirmed stable device position and effective left atrial appendage seal.

Implications:

• The transjugular approach is a technically feasible alternative for LAAC when transfemoral access is not possible.
• This method can lead to successful outcomes in anatomically challenging cases with appropriate technique and equipment.
• Expands treatment options for stroke prevention in complex atrial fibrillation patients.