Correlation analysis between left atrial appendage transesophageal echocardiography measurements and Watchman left atrial appendage occluder size

Abstract

Objective To evaluate the correlation between left atrial appendage (LAA) transesophageal echocardiography (TEE) measurements and Watchman LAA occluder size. Methods Consecutive 59 atrial fibrillation (AF) patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion under the guidance of TEE between October, 2014 and February, 2016. Measurements of the LAA anchoring area diameter and anatomical LAA orifice diameter including maximum, minimum and average values, and LAA depth on behalf of LAA size on 2D TEE, and anchoring area diameter including maximum, minimum and average values on 3D TEE were done before closer device implanation. The correlational analysis between TEE LAA diameter and Watchman LAA occluder size was conducted. Results Fifty-nine patients included 53 cases with successful LAA occlusion (peripheral leakage ≤5 mm), 3 cases with incomplete occlusion (peripheral leakage >5 mm ), and 3 cases with failed occlusion. Among 56 patients with device implanation, 43 had 3D TEE data. Maximum, minimum and average diameters of LAA anchoring area and LAA depth were (22.6±3.4)mm, (17.7±2.8)mm, (20.3±2.9)mm, (28.2±5.3)mm, respectively, and their coefficient of correlation r were 0.669, 0.564, 0.696, and 0.530, respectively ( all P=0.000) with Watchman device diameter. Maximum, minimum and average diameters of LAA anatomical orifice were (23.5±4.2)mm, (18.3±3.6)mm, (20.9±3.7)mm, respectively, and their coefficient of correlation r were 0.576, 0.610, 0.643 separately ( all P=0.000) with Watchman device diameter. Maximum, minimum and average diameters of LAA anchoring area were (22.2±4.3)mm, (18.2±3.9)mm, (20.2±3.7)mm, respectively with 3D TEE of 43 patients, and their coefficient of correlation r were 0.650, 0.655, 0.727, respectively ( all P=0.000) with Watchman device diameter. Conclusions Both 2D TEE and 3D TEE measurements of LAA have clinical guiding significance in the selection of proper size of Watchamn LAA occluder. The average diameter of 2D TEE and 3D TEE LAA anchoring area have the best correlation with Watchman device size, and have the most potency for the predicting the proper size of device. Key words: Echocardiography, transesophageal; Left atrial appendage; Occlusion; Watchman occluder