Safety and feasibility of Watchman device placement without pre-procedural imaging.

Background:
Percutaneous LAA closure is increasingly used to reduce the risk of stroke and thromboembolism in select patients with AFib. Typically, imaging such as transesophageal echocardiogram (TEE) or cardiac CT is performed to assess LAA morphology to guide device selection. We postulated that the LAA occluder device (Watchman) can be successfully placed using intra-procedural TEE and fluoroscopic guidance, without pre-procedural imaging.

Methods:
All patients from February to December 2018 who underwent Watchman device placement at Rush University Medical Center and had no pre-procedural imaging were included. Outcomes included: a) procedural success; b) complications (groin site, pericardial effusion/tamponade, myocardial infarction (MI), stroke, death) post procedure and at 45 days; c) device position, device dislodgement/thrombus, peri-device leak on 45 day TEE.

Results:
A total of 11 patients were analyzed. Mean age 75.5 years, 33.3% females, 66.7% Whites, mean CHA₂DS₂Vasc score 4.3±1.7 (Table1). Watchman device was successfully implanted in all patients without any residual peri-device leak. There were no groin site complications, or significant pericardial effusion, MI, stroke or death in the post procedure period and at 45 days. 5 of 11 patients completed follow up TEE at 45 days that showed good device position and no evidence of device dislodgement or thrombus. 3 patients had a small (<2 mm) peri-device leak on 45 day TEE (Table 2).

Conclusions:
LAA occlusion with the Watchman device can be safely performed using TEE and fluoroscopic guidance without pre-procedural imaging.