Left atrial catheter ablation subsequent to Watchman® left atrial appendage device implantation: a single centre experience.

Abstract

Left atrial appendage device occlusion is an increasingly accepted therapy for stroke prevention in atrial fibrillation. The feasibility and safety of left atrial catheter ablation procedures in the presence of a left atrial appendage device implant is unclear. We report on 10 cases of successful left atrial catheter ablation therapy for atrial fibrillation in patients with an implanted Watchman® device. Consecutive patients with an existing Watchman® left atrial appendage implant and symptomatic antiarrhythmic-drug refractory atrial fibrillation or atrial tachycardias requiring left atrial catheter ablation therapy were included. Open irrigated tip ablation and circular mapping catheters were positioned in the left atrium via double transseptal access. Ten patients underwent successful left atrial geometry creation and complex atrial arrhythmia mapping and ablation in the presence of a chronically implanted Watchman® device. Arrhythmia targets included left atrial flutters, a focal tachycardia, left atrial CFAE zones, and pulmonary vein electrical isolation. The appearances of the Watchman® device position and device integrity were confirmed to be satisfactory in all patients at the end of the procedure based on fluoroscopy and intracardiac echocardiography imaging. There were no procedural complications. Left atrial catheter ablation therapy in the presence of an implanted Watchman® left atrial appendage occlusion device was efficacious and uncomplicated in our small single centre experience.