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Updated: May 11, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Prevalence of Peridevice Leak in Patients With Left Atrial Appendage-Occlusion vs Without Electrically Isolated Left
Sanghamitra Mohanty1, Prem Geeta Torlapati1, Vincenzo Mirco La Fazia1
1Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Background:
Peridevice leak (PDL) is commonly observed after Watchman implantation for left atrial appendage occlusion (LAAO) in atrial fibrillation (AF). Because the LAA is actively contractile, it is fair to assume that some degree of device shifting could occur because of LAA contraction during the initial period of device implantation.
Objectives:
This study examined PDL prevalence in Watchman patients with vs without electrical isolation of LAA that consequentially leads to loss of contractility of the appendage.
Methods:
Consecutive patients with AF undergoing the Watchman procedure were included in the study and prospectively followed up. Based on prior LAA isolation (LAAI), patients were divided into Group 1 (prior LAAI) and Group 2 (no LAAI). In all patients in Group 1, electroanatomical mapping and transesophageal echocardiogram (TEE) were used to confirm LAAI and absence of contractility of the appendage before the Watchman implantation. Repeat TEE was scheduled at 45 to 60 days' post-Watchman implantation to assess for PDL on color Doppler. The leaks were reassessed by computed tomography imaging at 6 months. If leaks were detected during the first follow-up TEE, another TEE/computed tomography imaging was performed at 12 months to exclude persistent leak.
Results:
A total of 495 patients were included in Group 1 and 810 in Group 2. Baseline characteristics were comparable between groups. At the first follow-up TEE at 45 to 60 days, leaks of any size were noted in 90 (18.2%) patients in Group 1 and 199 (24.6%) patients in Group 2 (P = 0.007). The majority of the leaks in Group 2 were ≥3 mm in size (Group 1: 26 [28.9%] vs Group 2: 109 [54.8%]; P < 0.001). Prior LAAI was found to be an independent predictor (OR: 0.662; 95% CI: 0.488-0.900; P = 0.008) of lower risk of leaks.
Conclusions:
In this large prospective series of real-world patients, prior LAAI was seen to be associated with a lower risk of PDL in patients with AF and a Watchman device in situ.
