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Updated: Apr 23, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Retro-Curve Access Sheath for Retroverted Anatomy in Left Atrial Appendage Closure: Bench Validation and

Vlad Ciobotaru^1,2,3,4, Meyer Elbaz⁵, Xavier Iriart⁶

¹Cardiology Department, Hôpital Privé les Franciscaines, Nîmes, France.

Structural Heart : the Journal of the Heart Team

|April 22, 2026

Summary

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This summary is machine-generated.

Retroverted left atrial appendage (LAA) anatomies pose challenges for WATCHMAN device deployment. A novel retro-curve sheath design successfully restored axial alignment, improving procedural outcomes for these complex cases.

Area of Science:

Cardiology
Medical Devices
Anatomical Studies

Background:

Left atrial appendage (LAA) closure is a key stroke prevention strategy.
Retroverted LAA anatomies present unique challenges for device implantation.
Existing delivery systems may lead to suboptimal device positioning.

Purpose of the Study:

To evaluate the challenges of WATCHMAN device implantation in retroverted LAA anatomies.
To assess the performance of different sheath designs in patient-specific atrial models.
To introduce and evaluate a novel retro-curve sheath for improved coaxial alignment.

Main Methods:

Analysis of the LAA-Print registry for cases of retroverted LAA treated with WATCHMAN.
Bench testing using soft, patient-specific atrial models for 22 retroverted LAA cases.

Keywords:

3D printing Bench testing Coaxiality Left atrial appendage closure Patient-specific simulation Retrocurve access sheath design Retroverted left atrial appendage

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Comparison of double-curve and steerable sheaths versus a newly designed retro-curve sheath.

Main Results:

Retroverted LAA anatomies were associated with high rates of off-axis deployment, leak, and failure.
Standard delivery sheaths failed to achieve coaxial alignment despite optimization.
The newly designed retro-curve sheath successfully restored axial alignment irrespective of puncture site.

Conclusions:

Retroverted LAA anatomy is a significant predictor of procedural complications with WATCHMAN.
Current delivery sheaths are inadequate for achieving coaxial alignment in these challenging anatomies.
A novel retro-curve sheath offers a promising solution for improving LAA closure outcomes in retroverted LAA cases.