Procedural Outcomes of Watchman® Left Atrial Appendage Occluder Device Implantation and Longitudinal Toe Follow-Up of Peri-Device Leaks

Abstract

Background: We describe our procedural outcomes and technical success rates of Watchman® LAA closure devices from our centre with a focus on peri-device leaks. Results: Fifty-three patients aged 65.5 ± 7.3 years (range 43–82 years, 72% male, CHADS2 score 1.94 ± 0.9, CHADSVASC score 2.8 ± 1.0) underwent successful implantation of a Watchman® LAA occluder device in our centre since Nov 2009. Forty-four patients had concomitant pulmonary vein isolation (44/53). The average device size was 24 ± 3 mm (range 21–30 mm). No acute procedural complications occurred. Post implant transoesophageal echocardiogram (TOE) was performed at six weeks, and again at six months if any persistent peri-device leaks seen at initial follow up. At implant, 4/53 patients had a small peri-device leak detected on colour flow Doppler by TOE ≤ 3 mm. At six week TOE, 12 patients had a peri-device leak (nine new, three persistent), with four of these showing persistent small leaks at six month TOE (two present since implant). There was no significant age or sex distribution of patients who developed new peri-device leaks, however all patients who demonstrated leaks at implant were male. At six week follow up, the interatrial septal puncture sites had healed in all but 12 patients, with no age or sex distribution observed. Conclusion: Despite high procedural success rates and low incidence of peri-device leaks at implant, we have observed development of small leaks at first TOE follow-up in approximately 17% of patients which then tend to close again. This may reflect a period of “seating” with the device.