12 Observations by transoesophageal echocardiography post-watchman implantation in atrial fibrillation: a cause for concern?

IntroductionData regarding incidence of para-device leaks, persistent inter-atrial septal (IAS) defects and thrombus post-Watchman device implantation for atrial fibrillation is limited. We aimed to observe the incidence of para-device leaks, persistent IAS defects and thrombus detected by transoesophageal echocardiography (TOE), post-Watchman implantation.MethodsWe retrospectively identified all patients (n=112) who had a Watchman device implanted between 2014–2016 at 2 Beaumont Hospital and Mater Private Hospital by a single operator. Within this cohort, patients who had undergone post-procedural TOE were analyzed for evidence of para-device leaks, IAS defects (including patent foramen ovale (PFO)) and thrombus. Mean LA pressure was at least 12 mmHg for all patients to ensure volume loading for adequate sizing. Data were expressed as mean ± SD and %.ResultsBaseline demographic of all patients were age, 77 ± 7 years; male, 71%; CHADSVASC2 score, 4.3 ± 1.4; with left ventricular ejection fraction 51 ± 8%. All patients had a 14 F catheter across the inter-atrial septum to facilitate Watchman device delivery with mean size 26.8 ± 3.5 mm. Post-procedurally, 84% were on dual antiplatelet therapy and 16% were anti-coagulated for minimum duration of 8.6 ± 4.5 and 8.8 ± 4.3 weeks, respectively. 67% (n=75) had post-procedural TOE performed with duration from time of implant of 5.3 ± 4.2 months. Within this group, there was a 32% (n=24) incidence of para-device leaks post-Watchman implant. Size of leaks measured