Key result
Percutaneous left atrial appendage occlusion with the Watchman device significantly increased the LAA orifice area from 3.1 to 3.9 cm2 and made it more circular, without impacting left upper pulmonary vein hemodynamics.
Why the study?
Percutaneous left atrial appendage occlusion is increasingly performed, but its effects on LAA orifice geometry and adjacent left upper pulmonary vein hemodynamics required evaluation.
Does percutaneous LAA occlusion with the Watchman device alter LAA orifice geometry and LUPV hemodynamics in patients with non-valvular atrial fibrillation?
Observational (n=50)
No
Does percutaneous LAA occlusion with the Watchman device alter LAA orifice geometry and LUPV hemodynamics in patients with non-valvular atrial fibrillation?
Absolute Event Rate: 3.9% vs 3.1%
p-value: p=<0.001
LAA occlusion with the Watchman device significantly stretches the LAA orifice and makes it more circular without causing detrimental hemodynamic changes to the adjacent left upper pulmonary vein.
Watchman LAA occlusion alters orifice geometry without significantly affecting LUPV hemodynamics; leaves open clinical relevance and need for larger prospective studies.
Purpose: Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics. Methods: We included 50 consecutive patients who underwent percutaneous LAA occlusion with the Watchman device. Three-dimensional images of LAA pre- and post-device placement were analyzed offline. We measured the LAA orifice diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre- and post-procedure were also measured. Results: Patients were elderly (mean age 76±8 years years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1±3.2 vs. post-device 21.5±3.4 mm, p<0.001), diameter 2 (20.6±3.9 vs. 22.1±3.6 mm, p<0.001), minimum diameter (17.6±3.1 vs. 21.3±3.4 mm, p<0.001), maximum diameter (21.5±3.9 vs. 22.4±3.6 mm, p=0.022), circumference (63.6±10.7 vs. 69.6±10.5 mm, p<0.001), and area (3.1±1.1 vs. 3.9±1.2 cm 2 , p<0.001). Eccentricity index decreased after procedure (1.23±0.16 vs. 1.06±0.06, p<0.001). LUPV peak S and D velocities did not show a significant difference (0.29±0.15 vs. 0.30±0.14 cm/s, p=0.637; and 0.47±0.19 vs. 0.48±0.20 cm/s, p=0.549; respectively). Conclusion: LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.
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Ortiz‐León et al. (2021) conducted an observational in Non-valvular atrial fibrillation (n=50). Watchman device vs. Pre-device baseline was evaluated on Left atrial appendage orifice area (cm2) (p=<0.001). Percutaneous left atrial appendage occlusion with the Watchman device significantly increased the LAA orifice area from 3.1 to 3.9 cm2 and made it more circular, without impacting left upper pulmonary vein hemodynamics.
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