Intracardiac echocardiography- versus transesophageal echocardiography-guided left atrial appendage occlusion with Watchman FLX

J Cardiovasc Electrophysiol. 2021 Oct;32(10):2781-2784. doi: 10.1111/jce.15220. Epub 2021 Sep 5.

Abstract

Introduction: Watchman FLX has been recently approved for left atrial appendage occlusion (LAAO) in the US. Intracardiac echocardiography (ICE) - which is already commonly used to guide trans-septal access - can serve as an alternative to TEE, simplifying the procedure and reducing associated costs. Herein, we report our experience with ICE-guided LAAO with Watchman FLX.

Methods and results: This cohort study included the first 190 consecutive patients who underwent LAAO with Watchman FLX in our center. LAAO was successful in all patients without significant peri-procedural, device-related complications in either group. Compared to TEE, we observed a significant reduction in procedural times when using ICE. In addition, there was a potentially clinically relevant reduction in fluoroscopy dose, mainly secondary to fewer cine acquisition runs. At follow-up, no cases of device embolism were noted, whereas the rate of device-related thrombosis and peri-device leaks were comparable between groups.

Conclusion: ICE-guided LAAO with Watchman FLX is safe and feasible, with a significant reduction in procedural time and potential reduction in fluoroscopy dose when compared to TEE.

Keywords: Watchman FLX; intracardiac echocardiography; left atrial appendage closure; left atrial appendage occlusion.

MeSH terms

  • Atrial Appendage* / diagnostic imaging
  • Atrial Appendage* / surgery
  • Atrial Fibrillation* / diagnostic imaging
  • Atrial Fibrillation* / surgery
  • Cardiac Catheterization / adverse effects
  • Cohort Studies
  • Echocardiography, Transesophageal
  • Humans
  • Treatment Outcome
  • Ultrasonography, Interventional