Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices

Understanding the differences in the location and type of leaks and their clinical implications

Jayasree Pillarisetti, Yeruva Madhu Reddy, Sampath Gunda, Vijay Swarup, Randall Lee, Abdi Rasekh, Rodney Horton, Ali Massumi, Jie Cheng, Krzystzof Bartus, Nitish Badhwar, Frederick Han, Donita Atkins, Sudharani Bommana, Matthew Earnest, Jayant Nath, Ryan Ferrell, Steven Bormann, Buddhadeb Dawn, Luigi Di Biase & 3 others Moussa Mansour, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. Objective The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. Methods We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared. Results A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS<inf>2</inf> (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17%) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21%] vs 33 [14%]; P =.019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P =.001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks. Conclusion The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

Original languageEnglish (US)
Pages (from-to)1501-1507
Number of pages7
JournalHeart Rhythm
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Atrial Appendage
Equipment and Supplies
Stroke
Pericardiocentesis
Cardiac Tamponade
Pericardial Effusion
Heart Atria
Observational Studies
Heart Failure
Prospective Studies
Hypertension
Incidence

Keywords

  • Efficacy
  • Exclusion
  • Lariat
  • Left atrial appendage
  • Safety
  • Watchman device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices : Understanding the differences in the location and type of leaks and their clinical implications. / Pillarisetti, Jayasree; Reddy, Yeruva Madhu; Gunda, Sampath; Swarup, Vijay; Lee, Randall; Rasekh, Abdi; Horton, Rodney; Massumi, Ali; Cheng, Jie; Bartus, Krzystzof; Badhwar, Nitish; Han, Frederick; Atkins, Donita; Bommana, Sudharani; Earnest, Matthew; Nath, Jayant; Ferrell, Ryan; Bormann, Steven; Dawn, Buddhadeb; Di Biase, Luigi; Mansour, Moussa; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Heart Rhythm, Vol. 12, No. 7, 01.07.2015, p. 1501-1507.

Research output: Contribution to journalArticle

Pillarisetti, J, Reddy, YM, Gunda, S, Swarup, V, Lee, R, Rasekh, A, Horton, R, Massumi, A, Cheng, J, Bartus, K, Badhwar, N, Han, F, Atkins, D, Bommana, S, Earnest, M, Nath, J, Ferrell, R, Bormann, S, Dawn, B, Di Biase, L, Mansour, M, Natale, A & Lakkireddy, D 2015, 'Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications', Heart Rhythm, vol. 12, no. 7, pp. 1501-1507. https://doi.org/10.1016/j.hrthm.2015.03.020
Pillarisetti, Jayasree ; Reddy, Yeruva Madhu ; Gunda, Sampath ; Swarup, Vijay ; Lee, Randall ; Rasekh, Abdi ; Horton, Rodney ; Massumi, Ali ; Cheng, Jie ; Bartus, Krzystzof ; Badhwar, Nitish ; Han, Frederick ; Atkins, Donita ; Bommana, Sudharani ; Earnest, Matthew ; Nath, Jayant ; Ferrell, Ryan ; Bormann, Steven ; Dawn, Buddhadeb ; Di Biase, Luigi ; Mansour, Moussa ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices : Understanding the differences in the location and type of leaks and their clinical implications. In: Heart Rhythm. 2015 ; Vol. 12, No. 7. pp. 1501-1507.
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abstract = "Background Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. Objective The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. Methods We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared. Results A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS2 (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17{\%}) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21{\%}] vs 33 [14{\%}]; P =.019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P =.001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks. Conclusion The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.",
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T1 - Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices

T2 - Understanding the differences in the location and type of leaks and their clinical implications

AU - Pillarisetti, Jayasree

AU - Reddy, Yeruva Madhu

AU - Gunda, Sampath

AU - Swarup, Vijay

AU - Lee, Randall

AU - Rasekh, Abdi

AU - Horton, Rodney

AU - Massumi, Ali

AU - Cheng, Jie

AU - Bartus, Krzystzof

AU - Badhwar, Nitish

AU - Han, Frederick

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Earnest, Matthew

AU - Nath, Jayant

AU - Ferrell, Ryan

AU - Bormann, Steven

AU - Dawn, Buddhadeb

AU - Di Biase, Luigi

AU - Mansour, Moussa

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. Objective The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. Methods We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared. Results A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS2 (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17%) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21%] vs 33 [14%]; P =.019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P =.001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks. Conclusion The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

AB - Background Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. Objective The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. Methods We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared. Results A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS2 (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17%) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21%] vs 33 [14%]; P =.019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P =.001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks. Conclusion The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

KW - Efficacy

KW - Exclusion

KW - Lariat

KW - Left atrial appendage

KW - Safety

KW - Watchman device

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