eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2024
vol. 20
 
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abstract:
Original paper

Incidence and predictors of device-related thrombus after left atrial appendage closure with Watchman device

Jakub Maksym
1
,
Piotr Scisło
1
,
Agnieszka Kapłon-Cieślicka
1
,
Zenon Huczek
1
,
Michał Marchel
1
,
Janusz Kochman
1
,
Karol Zbroński
1
,
Grzegorz Opolski
1
,
Marcin Grabowski
1
,
Tomasz Mazurek
1

  1. First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Adv Interv Cardiol 2024; 20, 2 (76): 164–171
DOI: https://doi.org/10.5114/aic.2024.140315
Online publish date: 2024/06/05
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Introduction:
Left atrial appendage closure (LAAC) with Watchman device prevents thromboembolism in patients with atrial fibrillation (AF). However, thrombus may develop on the atrial surface of the device.

Aim:
To investigate the incidence and predictors of device-related thrombus (DRT) in patients with AF who were treated with LAAC.

Material and methods:
Ninety-one consecutive patients with AF underwent LAAC procedure using first-generation Watchman 2.5 device followed by antiplatelet therapy. In our analysis we have included all patients (n = 78) who had clinical follow-up visits with transesophageal echocardiography (TEE) after the procedure.

Results:
The median (IQR) CHA2DS2-VASc score was 4 (4.0–6.0) and HAS-BLED score was 3 (3.0–4.0). DRTs were observed in 5 (6.4%) patients. When compared with patients without DRT, those with DRT presented more often with lower median ejection fraction (40% (23.5–45.5) versus 55% (48.0–60.0); p = 0.005), lower emptying velocity of LAA (25 cm/s (17.5–27.0) versus 53 cm/s (26.5–78.0); p = 0.009), and with greater depth of implantation (18 mm (14.0–20.5) versus 8 mm (5.0–11.0); p < 0.001). Furthermore, patients with DRT had greater depth of LAA (35 mm (29.5–41.0) versus 29 mm (25.5–31.0); p = 0.003), greater mean (SD) dimension in 900 (22.4 mm (3.2) versus 19 mm (2.7); p = 0.02). Patients with DRT were also younger than those without DRT (67.4 years (7) versus 75 years (8.3), p = 0.045).

Conclusions:
The DRT after Watchman device implantation remains a rare complication. Its formation was related to several patient and procedural characteristics, which need to be confirmed in larger studies.

keywords:

antiplatelet therapy, atrial fibrillation, device-related thrombus, left atrial appendage closure, stroke prevention
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