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The Added Value of Preprocedural Cardiac Computed Tomography in Planning Left Atrial Appendage Closure With the Watchman FLX Device.

ABSTRACT: •Cardiac computed tomography (CCT) can be used as a useful complementary tool in preprocedural planning of left atrial appendage closure.•CCT planning includes assessing exclusion criteria, device sizing, sheath selection, anticipating challenging anatomies, and transseptal puncture planning.•Procedural 3D intracardiac echocardiography (3D-ICE) is increasingly being used instead of transesophageal echocardiography. In this setting, preprocedural CCT is useful to compensate for 3D ICE's reduced resolution.

SUBMITTER: Kassab J

PROVIDER: S-EPMC10513000 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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The Added Value of Preprocedural Cardiac Computed Tomography in Planning Left Atrial Appendage Closure With the Watchman FLX Device.

Kassab Joseph J Nakhla Shady S Miyasaka Rhonda L RL Saliba Walid W Ghobrial Joanna J Wazni Oussama O Kapadia Samir R SR Kanj Mohamed M Harb Serge C SC

Structural heart : the journal of the Heart Team 20230516 5

•Cardiac computed tomography (CCT) can be used as a useful complementary tool in preprocedural planning of left atrial appendage closure.•CCT planning includes assessing exclusion criteria, device sizing, sheath selection, anticipating challenging anatomies, and transseptal puncture planning.•Procedural 3D intracardiac echocardiography (3D-ICE) is increasingly being used instead of transesophageal echocardiography. In this setting, preprocedural CCT is useful to compensate for 3D ICE's reduced r ...[more]

PMID: 37745676

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Circumflex to Left Atrial Appendage Fistula Associated With Watchman FLX Closure Device.

Project description:An 82-year-old man who had undergone Watchman FLX (Boston Scientific) device implantation presented with dyspnea. Multimodality evaluation demonstrated a small fistula from the proximal circumflex artery to the left atrial appendage. Anatomically, the left circumflex artery is close to the atrial appendage; therefore, it is plausible that fistula formation could be a late complication of implantation of the device.

| S-EPMC10874893 | biostudies-literature

Device-Associated Thrombus with Watchman FLX Left Atrial Appendage Closure Device: A Report of Two Cases.

Project description: Not available

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First-in-human left atrial appendage closure using the WATCHMAN FLX Pro device: a case report.

Project description:BackgroundDevice-related thrombosis (DRT) is a known complication to left atrial appendage closure (LAAC). The surface of a LAAC device should ideally have antithrombotic properties. The novel WATCHMAN FLX Pro (WFP) incorporates a fluoropolymer-coated fabric membrane designed to increase thromboresistance and facilitate endothelialization. Such features could potentially allow for a minimal post-procedural antithrombotic regimen. Radiopaque platinum markers at the device shoulders and a large 40 mm device are other novel features of the WFP.Case summaryA 75-year-old man with atrial fibrillation was referred for LAAC due to prior subdural haemorrhage during direct-acting anticoagulation treatment. He underwent the first-in-human WFP implantation as part of the WATCHMAN FLX Pro CT study (NCT05567172). Computed tomography (CT) was used for pre-planning, and the procedure was performed under local analgesia guided by intracardiac echocardiography from the left atrium (LA) without any complications. Post-procedural antithrombotic treatment consisted of acetylsalicylic acid 75 mg/day only, and 45-day CT, transoesophageal echocardiography (TEE), and magnetic resonance imaging demonstrated optimal device position with complete LAAC. Hypoattenuated thickening (6 mm) appeared on the device as a smooth surface in continuity with the left atrial wall on CT and TEE. A specific magnetic resonance T1-weighted scan, used for visualization of fresh thrombus, suggested this to represent tissue ingrowth rather than thrombus.DiscussionThe advanced follow-up imaging protocol suggested a good WFP implantation result with signs of tissue ingrowth at 45 days. The added radiopaque markers facilitated optimal deployment, evaluation of device stability during tug test, and assessment of device protrusion into the LA.

| S-EPMC11014679 | biostudies-literature

Transfabric Leaks After Percutaneous Left Atrial Appendage Occlusion Procedures with the WATCHMAN FLX Device.

Project description:BackgroundCardiac computed tomography imaging with contrast is being used increasingly to image left atrial appendage occlusion (LAAO) devices. Contrast flow across a device, also known as a transfabric leak (TFL), may indicate a lack of complete LAAO-device endothelialization. The data on the rate, predictors, and clinical events associated with TFL are limited.MethodsAll patients who underwent an LAAO-device implantation with a WATCHMAN FLX device and received a postimplantation computed tomography scan were included in this single-centre retrospective cohort study. Patients were classified as either having or not having a TFL, according to 3 currently proposed definitions of TFL. Clinical and procedural differences between the 2 groups were determined. An exploratory univariate logistic regression model to evaluate predictors of TFL was constructed.ResultsA total of 56 individuals were included in the cohort. The rate of TFL varied from 27% to 52%, depending on the radiographic definition employed. No clinically important patient or procedural characteristics were noted between the groups with vs without TFL. No predictors of TFL were identified. Six deaths and one stroke occurred during a median follow-up period of 673 days.ConclusionsTFLs occur commonly post-LAAO procedures, suggesting that complete endothelialization of LAAO devices in humans may not be similar to that reported in animal models. Additional study into the best imaging approach to identify TFLs, and clinical events associated with TFLs, is necessary to clarify the significance of TFLs.

| S-EPMC11681346 | biostudies-literature

Post-release shift with Watchman FLX devices during left atrial appendage closure: the "popcorn effect".

Project description: Not available

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Watchman Left Atrial Appendage Closure After Incomplete AtriClip Closure.

Project description: Not available

| S-EPMC10236858 | biostudies-literature

WATCHMEN: a case report highlighting the closure of a bilobed left atrial appendage using two WATCHMAN-FLX devices

Project description: Not available

| S-EPMC10716089 | biostudies-literature

Cardiac computed tomography following Watchman FLX implantation: device-related thrombus or device healing?

Project description:AimsCardiac computed tomography (CT) is increasingly utilized during follow-up after left atrial appendage closure (LAAC). Hypoattenuated thickening (HAT) is a common finding and might represent either benign device healing or device-related thrombosis (DRT). The appearance and characteristics of HAT associated with the Watchman FLX have not been previously described. Therefore, we sought to investigate cardiac CT findings during follow-up after Watchman FLX implantation with a focus on HAT and DRT.Methods and resultsRetrospective single-centre, observational study including all patients with successful Watchman FLX implantation and follow-up cardiac CT between March 2019 and September 2021 (n = 244). Blinded analysis of CT images was performed describing the localization, extent, and morphology of HAT and correlated to imaging and histology findings in a canine model. Relevant clinical and preclinical ethical approvals were obtained.Overall, HAT was present in 156 cases (64%) and could be classified as either subfabric hypoattenuation (n = 59), flat sessile HAT (n = 78), protruding sessile HAT (n = 16), or pedunculated HAT (n = 3). All cases of pedunculated HAT and five cases of protruding sessile HAT were considered as high-grade HAT (n = 7). Subfabric hypoattenuation and flat sessile HAT correlated with device healing and endothelialization in histological analysis of explanted devices.ConclusionSubfabric hypoattenuation and flat sessile HAT are frequent CT findings for Watchman FLX, likely representing benign device healing and endothelialization. Pedunculated HAT and protruding HAT are infrequent CT findings that might represent DRT.

| S-EPMC9867931 | biostudies-literature

Comparative Endothelialization of the Watchman Plug Device and LACBES Pacifier Occluder after Left Atrial Appendage Closure

Project description: Not available

| S-EPMC11683694 | biostudies-literature

Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: Procedural and cost considerations.

Project description:BACKGROUND:Imaging guidance for left atrial appendage (LAA) closure (LAAC) conventionally consists of transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA). Intracardiac echocardiography (ICE) can eliminate the need for GA, expedite procedural logistics, and reduce the patient experience to a simple venous puncture. OBJECTIVE:The purpose of this study was to define optimal ICE views and compare procedural parameters and cost of ICE vs TEE during LAAC with the Watchman device. METHODS:Optimal ICE views of the LAA for Watchman implant were delineated using Carto-Sound and 3-dimensional rendition of the LAA in 6 patients. Procedural and financial parameters of 104 consecutive patients with standard indications for LAAC undergoing Watchman implant using ICE guidance through a single transseptal puncture (n = 53 [51%]) were compared with those of TEE-guided implants (n = 51 [49%]) in 3 centers. RESULTS:Clinical characteristics were similar between the 2 groups. Total in-room, turnaround, and fluoroscopy times all were shorter using ICE (P <.05) under local anesthesia compared to the TEE group. Implant success was 100% in both groups without peri-device leaks or procedural complications. Follow-up TEE showed no significant peri-device leak in both groups. Total hospital charges for ICE with local anesthesia vs TEE were similar, as were total hospital direct and indirect costs. Professional fees were significantly lower with ICE and local anesthesia than with TEE because the charge of anesthesia staff was avoided. CONCLUSION:ICE-guided Watchman implant is safe, feasible, and comparable in cost to TEE during LAAC with a Watchman device but avoids GA and expedites procedure turnaround.

| S-EPMC6400300 | biostudies-literature

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