Abstract 16647: Implantation of the Watchman Left Atrial Appendage Closure Device: A Comparison of TEE-Guidance vs ICE-Guidance
Background: High-risk patients with atrial fibrillation that are poor candidates for long-term oral anticoagulation are candidates for LAA occlusion with the Watchman device. Transesophageal echocardiography (TEE) is typically used to guide implantation.
Objective: We compared the utility and safety of the intracardiac echocardiography (ICE) from directly within the left atrium to guide device implantation.
Methods: The study included 117 consecutive patients who underwent Watchman implantation with TEE (n=95) or ICE (n=22) imaging guidance. ICE directly in the left atrium was used to perform the following tasks. 1) assessment of the LAA dimension for device sizing, 2) guidance of transseptal puncture, 3) verification of the delivery sheath position, 4) confirmation of location and stability of the device before and after, and 5) continuous monitoring to detect procedural complications. In 11 patients, we compared the measurement obtained by TEE and ICE to choose the size of the device.
Results: The device was successfully implanted in 116 patients (99%). There was no significant difference in average CHA2DS2-VASC score and HAS-BLED score between TEE and ICE groups respectively (4.4±1.4 vs. 4.7±1.6, p=0.46; 2.4±1.0 vs. 2.6±1.2, p=0.30). Six adverse events occurred: 1 cardiac tamponade, 1 retro-peritoneal bleed, and 2 groin hematomas with TEE guidance; and 2 groin hematomas with ICE guidance. The number of device recaptures was significantly less with ICE-guidance (0.48±0.8 vs. 0.88±1.4, p=0.004), and there was no significant difference in procedure time between groups (53±31 vs. 57±30 min, p=0.47). There was significant correlation in LAA measurements for device sizing assessed by ICE and TEE. (r=0.852, p=0.001)
Conclusion: ICE from directly in the left atrium was as effective as TEE in providing intraprocedural guidance for implantation of the Watchman device.
Author Disclosures: J. Iwasawa: None. Y. Enomoto: None. D. Sharma: None. C. Palaniswamy: None. S. Baluad: None. S. Choudry: None. N. Langan: None. M.A. Miller: None. J.S. Koruth: Research Grant; Modest; ACT, BIOSENSE WEBSTER, Vytronus. Consultant/Advisory Board; Modest; Biosense Webster, St Jude. Research Grant; Significant; MODEST, Significant, Significant. Consultant/Advisory Board; Significant; Significant, Signifcant. S.R. Dukkipati: None. V.Y. Reddy: Research Grant; Significant; Boston Scientific. Consultant/Advisory Board; Significant; Boston Scientific.
- © 2016 by American Heart Association, Inc.