Intracardiac echocardiography‐guided implantation of the Watchman FLX left atrial appendage closure device. (10th February 2021)

• Record Type: Journal Article
• Authors: Turagam, Mohit K.; Neuzil, Petr; Petru, Jan; Hala, Pavel; Mraz, Tomas; Baroch, Jiri; Lekesova, Veronika; Prokopova, Milena; Dukkipati, Srinivas R.; Reddy, Vivek Y.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 3(2021)
• Page Start: 717
• Page End: 725
• Publication Date: 2021-02-10
• Subjects: intracardiac echocardiography -- left atrial appendage occlusion -- stroke prevention -- Watchman FLX; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14927
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Background: The next‐generation Watchman FLX left atrial appendage closure (LAAC) device has: (1) an atraumatic closed distal end, (2) reduced height, (3) a recessed screw hub to decrease device‐related thrombus (DRT), (4) two rows of J‐shape anchors so redeployment is possible after full recapture, and (5) ability to treat a greater size range of LAA ostia. Objective: To report, for the first time, the feasibility and safety of intracardiac echocardiography (ICE)‐guided Watchman FLX implantation. Methods: A single‐center prospective registry of atrial fibrillation patients planned for LAAC with the FLX device underwent ICE‐guided implantation with conscious sedation. Transesophageal echocardiography (TEE) imaging was done preprocedure (to assess LAA size and exclude thrombus) and at clinical follow‐up at 6–12 weeks. Clinical outcomes were LAA closure success, complications, leak, or DRT on follow‐up TEE and major safety events. Results: The study included 30 patients: age 75 ± 8 years, 53% men, CHA2 DS2 ‐VASc 4.6 ± 1.6, and HAS‐BLED 3.4 ± 1.1. The primary indication was prior bleeding in 60% (72% GI bleeding). The LAA orifice width and length were 22.7 ± 3.1 and 25.7 ± 5.7 mm, respectively. Technical success was 100% (the first‐choice device was used in 28 of 30). Procedure time was less than 30 min in 27 of 30 cases, with 36 ± 15 ml contrast used. The final device size was 29.2 ± 4.7 mm with 21.6 ± 4.5% compression. There were no procedure‐related complications. Follow‐up TEE at a median 47 days follow‐up showed 100% device success with no DRT or peridevice leak ≥5 mm. Major safety events occurred in 6.6% (2/30). Conclusion: The Watchman FLX device can be safely implanted with intraprocedural ICE imaging instead of TEE.