Co-Author(s):
Poojita Shivamurthy, MD - Icahn School of Medicine at Mount Sinai
Lori Croft, MD
Iwanari Kawamura, MD
Mohit Turagam, MD
William Whang, MD
Srinivas Dukkipati, MD
Martin Goldman, MD - Icahn School of Medicine at Mount Sinai
Vivek Reddy, MD
Icahn School of Medicine at Mount Sinai
One Gustav Levy Place New York, NY 10029
Introduction | Objectives: Left atrial appendage closure (LAAC) has proven to be an effective
alternative to long term oral anticoagulation in the prevention of
thromboembolic events in patients with atrial fibrillation and elevated
CHA2DS2-VASc. In some patients,
inadequate seal may result in persistent peri-device flow and inability
of the appendage to fully thrombose – thereby representing a potential
source for thromboembolism. The objective of this abstract is to study
the use of endovascular coiling of the appendage to address persistent
peri-device leak in patients who have undergone appendage closure with
the Watchman device.
Methods: This is a retrospective, single-center analysis involving patients who
underwent placement of a Watchman LAAC device and returned for
endovascular coiling to address persistent device leak between
2018-2020. Baseline characteristics, procedural outcomes and follow-up
echocardiograms were analyzed to demonstrate the feasibility and safety
of this technique. Clinical outcomes were determined from review of
available chart documentation and follow up.
Results: Patients (N=20) were identified with a mean leak size of 3.8 ± 1.3 mm
(range 2.5 – 7 mm) all of whom had a non-thrombosed appendage. Acute
procedural success was achieved in 95% of patients. At eight-week
follow up imaging, complete or significant reduction in flow beyond the
appendage was achieved in 61% and 33% of patients respectively. The
one procedure-related adverse event was a pericardial effusion prior to
coil deployment, requiring percutaneous drainage. After a mean follow up
period of 16 ± 5.4 months, 85% (N=17) of patients remained off of
anticoagulation.
Conclusions: Identifying those at risk for thromboembolic events resulting from
peri-device leak post-Watchman implantation is a matter of continuing
investigation. However, appendage coiling represents a new therapeutic
tool to address this potential source for thromboembolism. Further
studies are required to address the clinical impact of this technique,
including the safety of discontinuing anticoagulation after successful
coiling.
AFS 2021-15