Abstract
Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Changes of LAA orifice size following LAAO and its impact on left upper pulmonary venous (LUPV) velocities
Highlights
The left atrial appendage (LAA) is the most common source of thrombi in patients with non-valvular AF, accounting for approximately 90% of cases.[1]
There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1, diameter 2 (20.6±3.9 vs. 22.1±3.6 mm, p
Based on current guidelines, percutaneous LAA occlusion can be considered in selected patients with non-valvular AF who are at increased risk of stroke and have contraindications to long-term anticoagulation.[2]. Based on recent randomized clinical trials that have demonstrated procedural safety and efficacy for ischemic stroke prevention with percutaneous LAA occlusion [3, 4], the US Food and Drug Administration has approved the Watchman device (Boston Scientific, Maple Grove, Minnesota) for use in percutaneous LAA occlusion
Summary
The left atrial appendage (LAA) is the most common source of thrombi in patients with non-valvular AF, accounting for approximately 90% of cases.[1]. The Watchman is the only device approved for LAA occlusion in the United States and has been increasingly utilized in real-world clinical practice[5]. The impact of the Watchman device on the LAA orifice and adjacent structures such as the left upper pulmonary vein (LUPV) is not well studied except in an animal model.[6]. Accurate assessment of anatomic LAA characteristics is crucial for correct sizing and safe placement of LAA closure devices.[10] Transesophageal echocardiography (TEE) is recommended before and during Watchman implantation to measure the LAA size[11]. [12,13,14,15] The aim of this study was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of LAA orifice using 3D TEE and assess its impact on the adjacent LUPV hemodynamics The depth and orifice diameters of the LAA are usually measured using twodimensional (2D) TEE, it has been shown that three-dimensional (3D) TEE is more accurate than 2D TEE and provides measurements that correlate better with those obtained by computed tomography. [12,13,14,15] The aim of this study was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of LAA orifice using 3D TEE and assess its impact on the adjacent LUPV hemodynamics
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