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