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The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population

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Abstract

Background

Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with thromboembolic and bleeding risk. We sought to determine the prevalence and characteristics of patients with AF ablation who are potential candidates for WATCHMAN implantation in a Japanese population.

Methods

We enrolled 2443 consecutive patients who had previously undergone AF ablation and transesophageal echocardiography (TEE). We assessed their clinical characteristics and measured their LAA orifice diameter and depth retrospectively using the obtained TEE images. We defined patients who met both anatomical criteria (LAA orifice max diameter: 17–31 mm and LAA max depth > LAA orifice max diameter) and clinical criteria (CHA2DS2-VASc score ≥ 2 and HAS-BLED score ≥ 3) as LAAO candidates.

Results

Among the 2443 enrolled patients, 361 (15%) met the clinical criteria, and 1928 (79%) met the anatomical criteria. Thus 12% (293/2443) of the total patient group met the criteria of LAAO candidates. LAAO candidates showed larger left atrial (LA) volume (77.6 ± 30.1 vs. 67.7 ± 29.1 mL, P < 0.001), larger LAA orifice diameter (22.5 ± 3.2 vs. 22.0 ± 4.3 mm, P = 0.026), and larger LAA depth (28.9 ± 4.6 vs. 27.0 ± 4.8 mm, P < 0.001). LAAO candidates made up only 23% of patients with CHA2DS2-VASc score ≥ 2 (N = 1295), whereas 78% of patients with a HAS-BLED score ≥ 3 (N = 378) were LAAO candidates.

Conclusion

Twelve percent of patients who underwent AF ablation were potential candidates for LAAO using a WATCHMAN device in this Japanese population. It is imperative to evaluate bleeding risk when considering the indications for LAAO.

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Authors and Affiliations

  1. Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan

    Yuta Kemi, Eiji Yamashita, Takehito Sasaki, Kentaro Minami, Yuko Miki, Koji Goto, Yutaka Take, Kohki Nakamura & Shigeto Naito

  2. Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Yuta Kemi, Eiji Yamashita, Takeshi Fujiwara & Kazuomi Kario

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  1. Yuta Kemi
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  2. Eiji Yamashita
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  3. Takeshi Fujiwara
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  4. Kazuomi Kario
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  5. Takehito Sasaki
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  6. Kentaro Minami
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  7. Yuko Miki
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  8. Koji Goto
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  9. Yutaka Take
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  11. Shigeto Naito
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Correspondence to Yuta Kemi.

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All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. This study was approved by the institutional review board of Gunma Prefectural Cardiovascular Center. Informed consent for inclusion in the study was obtained from all patients.

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Kemi, Y., Yamashita, E., Fujiwara, T. et al. The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population. J Echocardiogr 19, 243–249 (2021). https://doi.org/10.1007/s12574-021-00538-5

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  • DOI: https://doi.org/10.1007/s12574-021-00538-5

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