Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-217 - Watchman Implantation Using Multimodality Imaging In Patients With Long-Standing Persistent Atrial Fibrillation (ID 260)


Background: There are limited data describing multimodality imaging with computed tomography (CT) and transesophageal echocardiography (TEE) for left atrial appendage (LAA) assessment for Watchman implantation in patients with long-standing persistent (LSP) vs. paroxysmal/persistent (non-LSP) atrial fibrillation (AF).
Objective: To assess (1) LAA measurements, using CT and TEE, (2) final device size, and (3) residual leaks by TEE, in patients with LSP vs. non-LSP AF receiving the Watchman
Methods: We studied 136 patients who underwent Watchman implantations from 2016 to 2019 at our center. We compared maximal ostial diameter and depth using pre-procedural CT and intra-procedural TEE in LSP vs. non-LSP AF patients. We further assessed final device sizes and residual leaks, at time of implantation and at 6-week follow-up, using TEE in the two patient groups. Residual leaks were defined as mild (1-2.9 mm), moderate (3-5 mm), and severe (>5 mm).
Results: Our cohort consisted of 48 (35.3%) patients with LSP AF. Both LSP and non-LSP AF patients had larger LAA measurements by CT vs. TEE (Fig. 1A, 1B). Patients with LSP vs. non-LSP AF required larger device sizes (27, 30, and 33 mm): 85.4 vs. 60.9% (p<0.01). At implantation, LSP vs. non-LSP AF patients had similar rates of residual leaks, all mild or moderate: 7.9 vs. 6.3% (p=1.00). However, at 6 weeks, LSP vs. non-LSP AF patients were more likely to have moderate (25% vs. 14.5%, p=0.16) and severe (8.3% vs. 0%, p=0.02) leaks (Figure 2).
Conclusion: Measurements of the LAA are larger with CT than TEE, in both patients with LSP and non-LSP AF. Patients with LSP AF require larger devices, and are at greater risk for residual leaks at 6-week follow-up.