Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

Sharma, Sharan Prakash; Singh, David; Nakamura, Dean S; Gopinathannair, Rakesh; Lakkireddy, Dhanunjaya

doi:10.4022/jafib.2162

Cited by 16 publications

(1 citation statement)

References 14 publications

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“…The incidence is estimated to be much lower than other CIED infections given that endothelization of the device is expected within 45 days of implantation. However lack of endothelization has been described and this may be associated with higher risk of infection ( 33 ). The approach to Watchman ® device infection should be based on current infective endocarditis guidelines; which includes obtaining blood cultures and TEE when there is suspicion for infection ( Figure 7 ).…”

Section: Laao Device Infection (Watchman™ Infection)mentioning

confidence: 99%

Imaging of Cardiac Device-Related Infection

López-Aguilera

Hutt

Jaber

2021

Front. Cardiovasc. Med.

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Cardiac devices are frequently used in different cardiovascular conditions for the purpose of morbidity or mortality prevention. These include cardiac implantable electronic devices (CIED) like permanent pacemakers and implantable cardiac defibrillators, ventricular assistance devices (VADs), left atrial appendage occlusion (LAAO) devices like the Watchman™, atrial and ventricular septal occluders like the Amplatzer™, among others. In the past years, there has been an increase in the development of these devices as a result of a rise in the number of indications for implantation, paired with the aging and more medically complex patient population. This has led to an increase in the incidence of cardiac device-related infections, one of the most feared and serious complications which is associated with significant morbidity, mortality and financial burden. Accurate diagnosis of cardiac device-related infections is essential given the management implications which often involve removal of the infected device, removal of other prosthetic material and long-term antimicrobial therapy. Clinical and laboratory data are useful diagnostic tools but multimodality imaging is often necessary. The recently published 2020 European Heart Rhythm Association International Consensus document, which is endorsed by many expert societies, has recommended the use of multimodality imaging for the diagnosis of CIED infections. (1) This allows better disease characterization by identifying abnormal fluid collections and guiding aspiration for both diagnostic and therapeutic purposes (i.e. soft tissue ultrasound and computed tomography), evaluation for local extent of disease (i.e. transesophageal echocardiogram to evaluate for concomitant infective endocarditis), embolic manifestation of disease (i.e. computed tomography and magnetic resonance imaging) and metabolic tissue characterization (positron emission tomography and tagged white blood cell scan). (2) In addition, computed tomography (CT) allows for pre-procedural planning which has shown to be associated with better procedural outcomes.

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Section: Laao Device Infection (Watchman™ Infection)mentioning

confidence: 99%

Imaging of Cardiac Device-Related Infection

López-Aguilera

Hutt

Jaber

2021

Front. Cardiovasc. Med.

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Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Korsholm

Jensen

Nørgaard

et al. 2022

Cathet Cardio Intervent

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Background: The natural history of peridevice leak (PDL) following left atrial appendage occlusion (LAAO) is unknown. This study sought to investigate changes of PDL from 2 until 12 months after LAAO, using cardiac computed tomography (CT), and to assess the potential association between persistent PDL and clinical outcomes Methods: Single-center observational study of Amplatzer LAAO implants between 2010 and 2017 (n = 206). Patients with 2 and 12 months cardiac CT were included in the study (n = 153). Images were blindly analyzed. PDL was characterized by frequency and size at the device disc, lobe, and left atrial appendage contrast patency. Patients were followed for the composite outcome of ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death. Median follow up from LAAO was 3.1 (2.3-4.3) years.Results: Contrast patency was present in 101 (66%) and 72 (47%) (p < 0.001) at 2 and 12 months, respectively. PDL was identified at the disc in 103 (67%) patients at 2 months versus 93 (61%) at 12 months (p = 0.08), and at the lobe in 29 (19%) at both time points. PDL area at the disc did not change significantly over time, ∆ area: −8.95 mm (95% confidence interval [CI]: −18.9; 1.01) p = 0.08. Permanent atrial fibrillation was independently associated with persistent PDL. Persistent versus no PDL was associated with a 62% worse clinical outcome, however not statistically significant, hazard ratio (HR): 1.62 (95% CI: 0.9-2.93), p = 0.11. Conclusion:Persistent PDL was frequently observed following LAAO with Amplatzer devices. The PDL frequency and size appeared unchanged between 2 and 12 months. Persistent PDL was not significantly associated with worse clinical outcomes, yet this needs further delineation in future studies.

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Clinical relevance of incomplete device endothelialization after left atrial appendage closure

Chen

Xing

et al. 2022

Int J Cardiovasc Imaging

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This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization (IDE) after left atrial appendage closure (LAAC). MethodsA total of 101 consecutive patients with nonvalvular atrial brillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded. ResultsIDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not signi cantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-signi cantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32). ConclusionsIDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.

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Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

Cited by 16 publications

References 14 publications

Imaging of Cardiac Device-Related Infection

Imaging of Cardiac Device-Related Infection

Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Clinical relevance of incomplete device endothelialization after left atrial appendage closure

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