Transesophageal echocardiographic diagnosis of a WATCHMAN left atrial appendage closure device thrombus 10 years following implantation

Shamim, Shariq; Magalski, Anthony; Chhatriwalla, Adnan K.; Allen, Keith B.; Huber, Kenneth C.; Main, Michael L.

doi:10.1111/echo.13413

Cited by 16 publications

(7 citation statements)

References 4 publications

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“…A particular challenging and unanswered question is the optimal length, frequency, and method of surveillance in these patients, especially considering that many of the reported devicerelated thrombosis have been reported beyond 6 months after the procedure. [38][39][40][41]…”

Section: Residual Leakmentioning

confidence: 99%

Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation

Holmes

Alkhouli

Reddy

2019

Mayo Clinic Proceedings

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Oral anticoagulation is the dominant strategy for stroke prevention in patients with nonvalvular atrial fibrillation. However, lifelong oral anticoagulation is associated with major issues including inappropriate dosing, nonadherence, and adverse effects. Therefore, efforts have been made to develop sitespecific therapy aimed to occlude the left atrial appendage, the anatomical site accountable for more than 90% of nonvalvular atrial fibrillationerelated ischemic strokes. This review focuses on the growing literature to put into perspective the risk-balance ratio of left atrial appendage occlusion.

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Section: Residual Leakmentioning

confidence: 99%

Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation

Holmes

Alkhouli

Reddy

2019

Mayo Clinic Proceedings

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“…14,15 Up to now, there is only one randomized trial comparing LAA closure with OAC. 18,19 Progressive left atrial enlargement is a well-known phenomenon in permanent nAF and has also been documented after interventional LAA closure. Similarly, in the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies evaluating percutaneous LAA closure, new onset of heart failure after the procedure or measurements of natriuretic peptides are not included in the study design.…”

Section: Discussionmentioning

confidence: 99%

“…17 Peri-device leaks and thrombus formation on the device may occur as a complication of LAA closure even years after the procedure, and therapeutic options for these situations are still unclear. 18,19 Progressive left atrial enlargement is a well-known phenomenon in permanent nAF and has also been documented after interventional LAA closure. 20 This may result in the development of new peri-device leakage of an initially completely closed LAA during follow-up.…”

Section: Discussionmentioning

confidence: 99%

A 79‐year‐old woman with atrial fibrillation and new onset of heart failure

Nazarenus¹,

Stöllberger

2019

ESC Heart Failure

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As an alternative to oral anticoagulation, percutaneous left atrial appendage (LAA) closure is an increasingly performed procedure to prevent arterial embolism in patients with non‐valvular atrial fibrillation. Besides procedure‐related complications, residual leaks, device‐related thrombus formation, and dislocation of the LAA occluder have been observed during follow‐up. Heart failure as a consequence of interventional LAA closure has not been reported so far. This case report describes a 79‐year‐old lady with permanent non‐valvular atrial fibrillation presenting with New York Heart Association Class IV heart failure. Symptoms had started immediately after attempted LAA closure 11 months before. Transoesophageal echocardiography demonstrated two devices in the LAA, a large peri‐device leak, a mobile LAA thrombus, a right atrial appendage thrombus, and shunting via a patent foramen ovale. Under a maximally tolerated dose of heart failure medication and edoxaban, the patient remains without bleeding or embolism in New York Heart Association Class II. Because of its unique anatomical and endocrine properties, the LAA plays an important role in situations of pressure and volume overload. Interventional LAA closure interacts unfavourably with left atrial compliance and reservoir function. Atrial and brain natriuretic peptide secretion is known to be significantly reduced after LAA closure. Both mechanisms may result in the development of heart failure. Attempted LAA closure—instead of being the solution—may create new serious problems. Development of heart failure should be assessed, and a systematic search for late leaks after LAA closure should be performed in trials investigating safety and efficacy of this intervention.

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“…Incomplete endothelialization could provide a persistent prothrombotic surface for thrombus formation.Delayed device surface healing could potentially be related to thrombus formation that accompanies any device implantation (13). Device related thrombus (DRT) formation may be related to degree of LAAO device endothelialization [14] .…”

Section: Casementioning

confidence: 99%

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

Sharma

Singh

Nakamura

et al. 2019

Journal of Atrial Fibrillation

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Left atrial appendage occlusion (LAAO) is a promising alternative for stroke risk reduction in patients with non-valvular atrial fibrillation who are not suitable for long-term oral anticoagulation (OAC). Current practice mandates use of post-procedural OAC for 45 days after WatchmanTM placement duringwhich complete device endothelialization is expected to occur. However, most of theevidence supporting this strategy stem from animal studies. Incomplete device endothelialization are often encountered after 6-weeks of procedure and its therapeutic implications are less clear. Here, we present two cases of incomplete endothelialization after 1.5-and 2-year of Watchman implantation. In one of the cases, we believe thatan eccentric mitral regurgitation jet caused shearing force on the Watchman device and impeded with normal endothelialization. In the other case, we found a device related thrombus possibly favored by prothrombotic environment created by lack of endothelialization. Further studies are warranted to find predictors and better diagnostic tool of LAAO endothelialization.

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Transesophageal echocardiographic diagnosis of a WATCHMAN left atrial appendage closure device thrombus 10 years following implantation

Cited by 16 publications

References 4 publications

Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation

Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation

A 79‐year‐old woman with atrial fibrillation and new onset of heart failure

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

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