Percutaneous closure of the left atrial appendage: a new option for the prevention of thromboembolic stroke

Abstract

Percutaneous left atrial appendage (LAA) closure is an important therapeutic option for prevention of thromboembolic stroke in patients with atrial fibrillation (AF), especially when contraindications exist for oral anticoagulation. We aimed to evaluate our short-term results of LAA closure (initial experience) using the WATCHMAN LAA system. Eleven patients (8 men, 3 women; mean age 68.4±7.0 years) with nonvalvular AF, a high risk for cardioembolic stroke (mean CHADS2 score 2.6±1.2, mean CHA2DS2-VASc score 4.0±1.5), and contraindications to oral anticoagulation underwent percutaneous LAA closure using the WATCHMAN LAA system. All the procedures were performed under general anesthesia and fluoroscopy and transesophageal echocardiography (TEE) guidance. The patients were evaluated clinically (at 45 days and 6 months) and by TEE (at 45 days). The LAA was successfully occluded in all the patients (100%). The mean procedural and fluoroscopy times were 58.6±8.1 and 19.1±5.2 minutes, respectively. The mean diameter of the LAA ostium was measured as 20.4±3.8 mm by TEE. The mean device size was 24.6±3.8 mm. The mean hospital stay was 1.7±0.9 days. Follow-up TEE showed closure of all LAA orifices without device-related thrombus formation. Two patients (18.2%) had minimal peri-device leaks (<3 mm). None of the patients experienced major adverse events during a median follow-up of 90 days (interquartile range 60-185 days). Our initial experience suggests that percutaneous LAA closure with the WATCHMAN LAA system is safe and feasible, with favorable short-term clinical outcomes.