Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Re: Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Mac — Sat, 27 May 2023 05:08:54 +0000

I had the Watchman installed 14 months ago.

At the 6 week TEE it showed a “leak <3 mm,” and also the trans septal puncture hole had not healed.

Same at 6 month TEE and 14 month TEE.

I’m a bit concerned about both issues.

Edit: this is what it says

“ EXAM/PROCEDURE
A 2D transesophageal echocardiogram with Doppler and color flow Doppler was performed. 3D
images performed. The procedure was performed in the CLOUD. The study was technically
adequate. Transgastric views were not attempted.

Interpretation Summary
1. Watchman left atrial appendage occluder device well-seated.
2. Trace leak is redemonstrated similar to previous (< 3mm).
3. Iatrogenic ASD is seen with left to right shunt.”

Re: Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Daisy — Fri, 26 May 2023 20:25:39 +0000

Yes, it is interesting—especially the comments on the individual shape of the LAA, as patients have discussed the various shapes like “chicken wing” in relation to stroke risk but this brings up the issue that the Watchman is round and the opening of the LAA is likely not and the optimal ways to choose the right size Watchman and fit it. I see in my procedure report that they did a left atrial angiogram and measured the size of the opening of the LAA and then positioned the right size Watchman (there are 5 sizes) and to quote: “The device was deployed at the ostium of the left atrial appendage. Device position, size, compression, seal and stability were assessed. All criteria were met and the device was released from the delivery catheter. Intracardiac echocardiography were performed throughout the case to guide transseptal catheterization and to confirm the placement of the occlusion device.”

So again, you want someone with experience placing a Watchman!

”

Re: Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

LLA — Fri, 26 May 2023 19:19:09 +0000

Thank you Daisy for posting the link to the HRS conference. It is very interesting to watch. Now that I have a Watchman, I'm finding it helpful to learn more about it. Hope you are doing well since your Watchman procedure too!

Re: Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Daisy — Thu, 25 May 2023 14:58:09 +0000

Quote
Mac
Thanks.

I’m struggling with some Watchman issues, so that was interesting.

Do you care to say more? For those interested in Watchman, every person’s experience adds to our understanding.

Re: Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Mac — Thu, 25 May 2023 04:21:06 +0000

Thanks.

I’m struggling with some Watchman issues, so that was interesting.

Watchman: “acceptable” leaks, importance of imaging—latest from the HRS Conference

Daisy — Thu, 25 May 2023 00:18:06 +0000

I found this interesting as they are narrowing the “acceptable” leak threshold to somewhere between 2-3 mm as larger leaks are proving to be stroke risks. The discussion also covers the pluses and minuses of TEE and CT imaging in detecting leaks, the possible significance of the LAA shape, and ways of mitigating the possibility of leaks during implantation. Also, methods of fixing leaks. [youtu.be]