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Journal of Interventional Cardiology
Volume 2019, Article ID 4525084, 7 pages
Clinical Study

Left Atrial Appendage Management with the Watchman Device during Hybrid Ablation of Atrial Fibrillation

1Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
2Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
3Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
4Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium

Correspondence should be addressed to Mindy Vroomen; moc.liamg@1nemoorvydnim

Received 7 March 2019; Accepted 28 May 2019; Published 26 June 2019

Academic Editor: Thach N. Nguyen

Copyright © 2019 Mindy Vroomen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. In the recent ESC/EACTS guidelines, left atrial appendage (LAA) occlusion or exclusion in patients undergoing (thoracoscopic) atrial fibrillation (AF) ablation surgery is recommended. The Watchman device (WD, Boston Scientific, Minnesota) has proved to reduce the risk of thromboembolic events by closing of the LAA, yet no data exist on WD implantation during surgical AF ablation. The objective is to determine if WD implantation is safe and feasible in a hybrid AF ablation setting (i.e., combination of thoracoscopic epicardial surgical and endocardial catheter ablation) and could become subject of further testing to serve as a bail-out in cases in which surgical LAA occlusion methods cannot be applied, due to, for example, severe adhesions. Methods. In this prospective, single center, pilot study, 10 consecutive patients undergoing a hybrid ablation qualifying for LAA exclusion (CHA2DS2-VASc ≥ 1) were included. At the end of the hybrid ablation, the LAA was occluded endocardially using the WD. The feasibility endpoint was successful implantation. The safety endpoint concerned major complications. Results. One patient was excluded and replaced because the LAA was insufficiently visible on transesophageal echocardiography. In 10/11 patients, device delivery was successful (mean time: 35 minutes). No major complications occurred. Transesophageal echocardiography after 6 weeks and 6 months showed successful occlusion of the LAA without significant peridevice flow. Conclusion. Implantation of the WD seems to be feasible and safe in the setting of hybrid AF ablation and could be an alternative to epicardial occlusion in surgical AF ablation procedures. Larger studies are required to confirm these findings. This trial is registered with NCT02471131.