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Background: For patients with nonvalvular atrial fibrillation (NVAF), left atrial appendage closure (LAAC) is an alternative to oral anticoagulants (OACs). However, incomplete device endothelialization (IDE) after LAAC has been linked to device-related thrombus (DRT) and subsequent thromboembolic events. Here, the differences in device endothelialization between the Watchman plug device and the LACBES pacifier occluder after implantation were investigated.
Methods: Of 201 consecutive patients with indications for LAAC, 101 received a Watchman 2.5 device, and 100 received a LACBES occluder. IDE was defined as a residual flow of contrast agent inside the left atrial appendage (LAA) on cardiac computed tomography angiography (CCTA) without peri-device leak (PDL) at the 3-month and 6-month follow-ups.
Results: There were no significant differences in DRT or PDL incidence between the two groups. However, the IDE rate in the absence of PDL was higher in the LACBES group than in the Watchman group at 3 months (42.4% versus 25.8%; = 0.025) and at the 6-month follow-up (24.7% versus 11.2%; = 0.028) as determined by CCTA.
Conclusions: Our findings indicated that the LACBES occluder took longer to complete endothelialization than the Watchman device after successful LAAC therapy. CCTA is a reliable imaging method for assessing the sealing of LAAC devices and confirming complete device endothelialization.
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http://dx.doi.org/10.31083/j.rcm2512450 | DOI Listing |
Expert Opin Drug Saf
August 2025
Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS, USA.
Introduction: Left atrial appendage occlusion (LAAO) is a viable alternative to anticoagulation for treatment in patients with non-valvular atrial fibrillation (NVAF) who cannot tolerate anticoagulation. Post-procedure patients are generally prescribed oral anticoagulation (OAC) for 45 days, while the device is undergoing endothelialization, following which patients are continued on antiplatelet agents. Recommendations for antithrombotic agents following LAAO arrived by consensus, which are not tolerated by all patients.
View Article and Find Full Text PDFInt J Cardiol
September 2025
Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Background & Objectives: Incomplete endothelialization of the left atrial appendage(LAA) occluder potentially affects the long-term efficacy of stroke prevention in atrial fibrillation(AF) patients. This study aims to explore the value of routine preoperative transthoracic echocardiography(TTE) in predicting the endothelialization of Watchman LAA occluder.
Methods: This single-center retrospective study included 437 AF patients who underwent the LAA closure with Watchman 2.
JACC Asia
March 2025
Department of Cardiology of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China; Research Center for Life S
Background: We previously pioneered a negatively ionized polyethylene terephthalate membrane method (the SMART technique) with the LAMax (test) occluder to reduce platelet adhesion and promote endothelialization.
Objectives: This study aimed to compare the safety and efficacy of the test occluder with the Watchman 2.5 device (control) in patients with nonvalvular atrial fibrillation to reduce stroke risk.
Rev Cardiovasc Med
December 2024
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011 Shanghai, China.
CJC Open
December 2024
Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Background: Cardiac computed tomography imaging with contrast is being used increasingly to image left atrial appendage occlusion (LAAO) devices. Contrast flow across a device, also known as a transfabric leak (TFL), may indicate a lack of complete LAAO-device endothelialization. The data on the rate, predictors, and clinical events associated with TFL are limited.
View Article and Find Full Text PDF