Intracardiac echocardiography‐guided implantation of the Watchman FLX left atrial appendage closure device

• Published in: Journal of cardiovascular electrophysiology Vol. 32; no. 3; pp. 717 - 725
• Main Authors: Turagam, Mohit K., Neuzil, Petr, Petru, Jan, Hala, Pavel, Mraz, Tomas, Baroch, Jiri, Lekesova, Veronika, Prokopova, Milena, Dukkipati, Srinivas R., Reddy, Vivek Y.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2021
• Subjects: Bleeding; Blood clots; Compression; Echocardiography; Fibrillation; intracardiac echocardiography; left atrial appendage occlusion; Safety; stroke prevention; Success; Thrombosis; Watchman FLX; left atrial appendage occlusion; intracardiac echocardiography; stroke prevention; Watchman FLX
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.14927

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, CHA2DS2‐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.