Author + information
- Received January 9, 2019
- Revision received March 5, 2019
- Accepted April 2, 2019
- Published online June 3, 2019.
- Matthew S. Glassy, MD∗,
- William Wung, MD∗,
- Sarah Westcott, MD,
- Thomas W.R. Smith, MD,
- Dali Fan, MD,
- Jason H. Rogers, MD and
- Gagan D. Singh, MD∗ ()
- ↵∗Address for correspondence:
Dr. Gagan D. Singh, UC Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, California 95817.
Objectives This study sought to compare patients with and without long-standing persistent atrial fibrillation (LSPAF) undergoing Watchman left atrial appendage (LAA) occlusion.
Background An increased burden of atrial fibrillation is associated with progressive left atrial remodeling and enlargement.
Methods Transesophageal echocardiography (TEE) measures of LAA ostial diameter and depth, device compression, and residual leak were evaluated in 101 consecutive Watchman cases. The patients were categorized into LSPAF (n = 48) or non-LSPAF (n = 53) groups and compared.
Results The average LAA ostial diameter for LSPAF versus non-LSPAF by TEE omniplane at 0° was 21.1 ± 4.1 mm versus 18.2 ± 3.6 mm (p = 0.0002); at 45° was 18.7 ± 3.4 mm versus 16.3 ± 3.1 mm (p = 0.0004); at 90° was 19.6 ± 3.8 mm versus 16.2 ± 3.4 mm (p = 0.00001); and at 135° was 21.0 ± 4.1 mm versus 18.0 ± 4.1 mm (p = 0.0005). The average LAA depth for LSPAF versus non-LSPAF by TEE at 0° was 28.1 ± 6.4 mm versus 25.2 ± 4.9 mm (p = 0.02); at 45° was 27.9 ± 5.8 mm versus 25.1 ± 4.3 mm (p = 0.007); at 90° was 27.2 ± 5.2 mm versus 22.8 ± 3.7 mm (p = 0.0001); and at 135° was 25.6 ± 5.4 mm versus 21.5 ± 3.8 mm (p = 0.0001). In successfully treated patients, 77% of the LSPAF group received larger device (27, 30, or 33 mm) implants versus only 46% in the non-LSPAF group (p = 0.003). While both groups had similar rates of moderate (3 to 5 mm) leaks at implant (2% vs. 0%; p = 0.14), 27% of the LSPAF vs. 4% of the non-LSPAF group had moderate leaks (p = 0.04) on 6-week follow-up TEE.
Conclusions Patients with LSPAF have significantly larger LAA sizes, require larger devices, and have more residual leak on follow-up TEE. LSPAF may represent a higher risk group that warrants more stringent long-term follow-up.
- left atrial appendage occlusion
- long-standing persistent atrial fibrillation
- peridevice leak
- Watchman device
↵∗ Drs. Glassy and Wung contributed equally to this work.
Dr. Smith has served as a consultant for Boston Scientific, Gore Medical, and Abbott Vascular; and owns equity in Millipede Medical. Dr. Rogers has served on the advisory board for Boston Scientific. Dr. Singh has served as an educational consultant and on the Speakers Bureau for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 9, 2019.
- Revision received March 5, 2019.
- Accepted April 2, 2019.
- 2019 American College of Cardiology Foundation
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