Left Atrial Appendage Management with the Watchman Device during Hybrid Ablation of Atrial Fibrillation

Mindy Vroomen, Bart Maesen, Justin G Luermans, Harry J Crijns, Jos G Maessen, Mark La Meir, Laurent Pison, Mindy Vroomen, Bart Maesen, Justin G Luermans, Harry J Crijns, Jos G Maessen, Mark La Meir, Laurent Pison

Abstract

Background: In the recent ESC/EACTS guidelines, left atrial appendage (LAA) occlusion or exclusion in patients undergoing (thoracoscopic) atrial fibrillation (AF) ablation surgery is recommended. The Watchman device (WD, Boston Scientific, Minnesota) has proved to reduce the risk of thromboembolic events by closing of the LAA, yet no data exist on WD implantation during surgical AF ablation. The objective is to determine if WD implantation is safe and feasible in a hybrid AF ablation setting (i.e., combination of thoracoscopic epicardial surgical and endocardial catheter ablation) and could become subject of further testing to serve as a bail-out in cases in which surgical LAA occlusion methods cannot be applied, due to, for example, severe adhesions.

Methods: In this prospective, single center, pilot study, 10 consecutive patients undergoing a hybrid ablation qualifying for LAA exclusion (CHA2DS2-VASc ≥ 1) were included. At the end of the hybrid ablation, the LAA was occluded endocardially using the WD. The feasibility endpoint was successful implantation. The safety endpoint concerned major complications.

Results: One patient was excluded and replaced because the LAA was insufficiently visible on transesophageal echocardiography. In 10/11 patients, device delivery was successful (mean time: 35 minutes). No major complications occurred. Transesophageal echocardiography after 6 weeks and 6 months showed successful occlusion of the LAA without significant peridevice flow.

Conclusion: Implantation of the WD seems to be feasible and safe in the setting of hybrid AF ablation and could be an alternative to epicardial occlusion in surgical AF ablation procedures. Larger studies are required to confirm these findings. This trial is registered with NCT02471131.

Conflict of interest statement

To support the research presented herein Laurent Pison reports a grant from Boston Scientific to the Cardiovascular Research Institute Maastricht (CARIM) at the University of Maastricht. Dr. La Meir reports a relationship with AtriCure and Medtronic.

Copyright © 2019 Mindy Vroomen et al.

Figures

Figure 1
Figure 1
Watchman device implantation - Intraoperative images. (a) Left-sided thoracoscopic view of the left atrial appendage (LAA) before implantation. PV = Pulmonary vein. (b) Left-sided thoracoscopic view of the LAA after implantation, showing that implantation of the device does not lead to significant morphological changes of the LAA. (c) Per-procedural echocardiographic view after implantation. (d) Per-procedural thoracic radiographic image after implantation. His = His Bundle catheter, CS = Coronary Sinus catheter.

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Source: PubMed

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