Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Feb 26;7(2):65-75.
doi: 10.4330/wjc.v7.i2.65.

Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device

Sven Möbius-Winkler  1 , Nicolas Majunke  1 , Marcus Sandri  1 , Norman Mangner  1 , Axel Linke  1 , Gregg W Stone  1 , Ingo Dähnert  1 , Gerhard Schuler  1 , Peter B Sick  1
Affiliations
Review

Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device

Sven Möbius-Winkler et al. World J Cardiol. .

Abstract

Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.

Keywords: Atrial fibrillation; Complications; Left atrial appendage; Stroke prevention; WATCHMAN® device.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Devices for percutaneous occlusion of the left atrial appendage. A: PlAATO® device; B: Amplatzer® cardiac plug; C: Watchman® device.
Figure 2
Figure 2
Left atrial appendage. A: With thrombus; B: Without thrombus. LAA: Left atrial appendage.
Figure 3
Figure 3
Echocardiography in transseptal puncture. A: Tenting of transseptal needle at the middle part of the atrial septum; B: Access sheath passing through the atrial septum within left atrium. LAA: Left atrial appendage.
Figure 4
Figure 4
Measurement of the left atrial appendage during implantation procedure. A: After angiography (RAO 25°, caudal 20°)-measurement of ostium size (22 mm) and depth (28 mm); B: Echocardiographic measurement at around 135° of ostium size (20 mm) and depth (25 mm).
Figure 5
Figure 5
Deployment of a Watchman® device (fluoroscopic views). A: Deployment sheath in correct position; B: Watchman device loaded within the sheath before deployment; C: Watchman device deployment; D: Watchman device completely deployed within the LAA. LAA: Left atrial appendage.
Figure 6
Figure 6
Optimal position of the Watchman device within the left atrial appendage. A: Angiographic view (RAO 25° caudal 20°); B: Echocardiographic view. Indicates inferior transition from left atrial appendage to LA (star).
Figure 7
Figure 7
Pericardial effusion. A: Angiographic view; B: Echo view. LAA: Left atrial appendage.
Figure 8
Figure 8
Air embolism. A: Air bubble within the left atrial appendage; B: Right coronary artery (RCA) filled with air (bright shadows); C: RCA with large air bubble; D: Placement of a aspiration catheter (EXPORT, Medtronic) within the RCA; E: RCA after successful aspiration of air bubbles without filling defect. LAA: Left atrial appendage
Figure 9
Figure 9
Device embolisation of watchman-device. A: Within the left atrial appendage immediately after release (arrow indicates device); B: Embolisation from the left atrial appendage; C: Passage of the aortic valve; D: Device within the lower thoracic aorta after embolization.
Figure 10
Figure 10
Device retrieval after embolization. A: Watchman device within the lower thoracic aorta after embolization; B: Snaring of the Watchman device with a goose neck snare 20 mm; C: Retraction of the device into the right arteria iliaca; D: Device retracted into a large (14 Fr.) sheath.
Figure 11
Figure 11
Thrombus formation (1.0 cm x 1.3 cm) 45 d after implantation on a Watchman device (A) and schematic view: Thrombus, device and left atrial appendage are highlighted (B).
See this image and copyright information in PMC

References

    1. Kirshner HS. Differentiating ischemic stroke subtypes: risk factors and secondary prevention. J Neurol Sci. 2009;279:1–8. - PubMed
    1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755–759. - PubMed
    1. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Europace. 2010;12:1360–1420. - PubMed
    1. Baker WL, Cios DA, Sander SD, Coleman CI. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm. 2009;15:244–252. - PMC - PubMed
    1. Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med. 1999;131:927–934. - PubMed