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Anesthesia and Transesophageal Echocardiography for WATCHMAN Device Implantation

Published:August 30, 2016DOI:https://doi.org/10.1053/j.jvca.2016.06.012
      ONLY 30% TO 50% of patients with nonvalvular atrial fibrillation are treated with anticoagulation to reduce the risk of thromboembolic events due to patient adherence and the side effect profile of such therapy.
      • Mobius-Winkler S.
      • Sandri M.
      • Mangner N.
      • et al.
      The WATCHMAN left atrial appendage closure device for atrial fibrillation.
      Several left atrial appendage occlusion devices have been proposed as alternative approaches to minimize the risk of thromboembolic events. This article reviews the anesthetic and transesophageal echocardiographic (TEE) implications of WATCHMAN left atrial appendage closure device (Boston Scientific, Marlborough, MA) implantation.

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      References

        • Mobius-Winkler S.
        • Sandri M.
        • Mangner N.
        • et al.
        The WATCHMAN left atrial appendage closure device for atrial fibrillation.
        J Vis Exp. 2012; 60
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        Heart disease and stroke statistics—2015 update: A report from the American Heart Association.
        Circulation. 2015; 131 (e29-322)
        • Feigin V.L.
        • Forouzanfar M.H.
        • Krishnamurthi R.
        • et al.
        Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010.
        Lancet. 2014; 383: 245-254
        • Elijovich L.
        • Josephson S.A.
        • Fung G.L.
        • et al.
        Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: A study of 30-day cardiac event monitors.
        J Stroke Cerebrovasc Dis. 2009; 18: 185-189
        • Hart R.G.
        • Pearce L.A.
        • Aguilar M.I.
        Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
        Ann Intern Med. 2007; 146: 857-867
        • Connolly S.J.
        • Ezekowitz M.D.
        • Yusuf S.
        • et al.
        Dabigatran versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2009; 361: 1139-1151
        • Giugliano R.P.
        • Ruff C.T.
        • Braunwald E.
        • et al.
        Edoxaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2013; 369: 2093-2104
        • Granger C.B.
        • Alexander J.H.
        • McMurray J.J.
        • et al.
        Apixaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2011; 365: 981-992
        • Patel M.R.
        • Mahaffey K.W.
        • Garg J.
        • et al.
        Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Engl J Med. 2011; 365: 883-891
        • Landmesser U.
        • Holmes Jr, D.R.
        : Left atrial appendage closure: A percutaneous transcatheter approach for stroke prevention in atrial fibrillation.
        Eur Heart J. 2012; 33: 698-704
        • Lanigan M.J.
        • Chaney M.A.
        • Nathan S.
        • et al.
        Case 4-2015: Use of the Lariat device for left atrial appendage closure.
        J Cardiothorac Vasc Anesth. 2015; 29: 522-531
        • Bartus K.
        • Han F.T.
        • Bednarek J.
        • et al.
        Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: Initial clinical experience.
        J Am Coll Cardiol. 2013; 62: 108-118
        • Pillarisetti J.
        • Reddy Y.M.
        • Gunda S.
        • et al.
        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. 2015; 12: 1501-1507
        • Massumi A.
        • Chelu M.G.
        • Nazeri A.
        • et al.
        Initial experience with a novel percutaneous left atrial appendage exclusion device in patients with atrial fibrillation, increased stroke risk, and contraindications to anticoagulation.
        Am J Cardiol. 2013; 111: 869-873
        • Di Biase L.
        • Burkhardt J.D.
        • Mohanty P.
        • et al.
        Left atrial appendage: An underrecognized trigger site of atrial fibrillation.
        Circulation. 2010; 122: 109-118
        • Han F.T.
        • Bartus K.
        • Lakkireddy D.
        • et al.
        The effects of LAA ligation on LAA electrical activity.
        Heart Rhythm. 2014; 11: 864-870
        • Kanderian A.S.
        • Gillinov A.M.
        • Pettersson G.B.
        • et al.
        Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography.
        J Am Coll Cardiol. 2008; 52: 924-929
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2014; 64 (e1-76)
        • Camm A.J.
        • Lip G.Y.
        • De Caterina R.
        • et al.
        2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association.
        Europace. 2012; 14: 1385-1413
        • Al-Saady N.M.
        • Obel O.A.
        • Camm A.J.
        Left atrial appendage: Structure, function, and role in thromboembolism.
        Heart. 1999; 82: 547-554
        • Yu C.M.
        • Khattab A.A.
        • Bertog S.C.
        • et al.
        Mechanical antithrombotic intervention by LAA occlusion in atrial fibrillation.
        Nat Rev Cardiol. 2013; 10: 707-722
        • Di Biase L.
        • Santangeli P.
        • Anselmino M.
        • et al.
        Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study.
        J Am Coll Cardiol. 2012; 60: 531-538
        • Gage B.F.
        • Waterman A.D.
        • Shannon W.
        • et al.
        Validation of clinical classification schemes for predicting stroke: Results from the National Registry of Atrial Fibrillation.
        JAMA. 2001; 285: 2864-2870
        • Lane D.A.
        • Lip G.Y.
        Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.
        Circulation. 2012; 126: 860-865
        • Lip G.Y.
        • Tse H.F.
        • Lane D.A.
        Atrial fibrillation.
        Lancet. 2012; 379: 648-661
        • Holmes Jr, D.R.
        • Kar S.
        • Price M.J.
        • et al.
        Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial.
        J Am Coll Cardiol. 2014; 64: 1-12
        • Fountain R.B.
        • Holmes D.R.
        • Chandrasekaran K.
        • et al.
        The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial.
        Am Heart J. 2006; 151: 956-961
        • Holmes D.R.
        • Reddy V.Y.
        • Turi Z.G.
        • et al.
        Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial.
        Lancet. 2009; 374: 534-542
        • Chue C.D.
        • de Giovanni J.
        • Steeds R.P.
        The role of echocardiography in percutaneous left atrial appendage occlusion.
        Eur J Echocardiogr. 2011; 12: i3-10
        • Shah S.J.
        • Bardo D.M.
        • Sugeng L.
        • et al.
        Real-time three-dimensional transesophageal echocardiography of the left atrial appendage: Initial experience in the clinical setting.
        J Am Soc Echocardiogr. 2008; 21: 1362-1368
        • Brinkman V.
        • Kalbfleisch S.
        • Auseon A.
        • et al.
        Real time three-dimensional transesophageal echocardiography-guided placement of left atrial appendage occlusion device.
        Echocardiography. 2009; 26: 855-858
        • Nakajima H.
        • Seo Y.
        • Ishizu T.
        • et al.
        Analysis of the left atrial appendage by three-dimensional transesophageal echocardiography.
        Am J Cardiol. 2010; 106: 885-892
        • Saw J.
        • Lempereur M.
        Percutaneous left atrial appendage closure: Procedural techniques and outcomes.
        JACC Cardiovasc Interv. 2014; 7: 1205-1220
        • Chan N.Y.
        • Lau C.L.
        • Tsui P.T.
        • et al.
        Experience of left atrial appendage closure performed under conscious sedation.
        Asian Cardiovasc Thorac Ann. 2015; 23: 394-398
        • MacDonald S.T.
        • Newton J.D.
        • Ormerod O.J.
        Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia.
        Catheter Cardiovasc Interv. 2011; 77: 124-127