title: Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Arizona Heart Rhythm Center, Phoenix, Arizona.
authors.forename: Vijay
authors.initials: V
authors.lastname: Swarup
authors.affiliation: University of San Francisco, San Francisco, California.
authors.forename: Randall
authors.initials: R
authors.lastname: Lee
authors.affiliation: Texas Heart Institute, St. Lukes Hospital, Houston, Texas.
authors.forename: Abdi
authors.initials: A
authors.lastname: Rasekh
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.affiliation: Texas Heart Institute, St. Lukes Hospital, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Massumi
authors.affiliation: Texas Heart Institute, St. Lukes Hospital, Houston, Texas; University of Texas, Houston, Texas.
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: John Paul II, Krakow, Poland.
authors.forename: Krzystzof
authors.initials: K
authors.lastname: Bartus
authors.affiliation: University of San Francisco, San Francisco, California.
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Frederick
authors.initials: F
authors.lastname: Han
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Earnest
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferrell
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Steven
authors.initials: S
authors.lastname: Bormann
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@gmail.com.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000209:etiology*; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000379:methods; D055989:Septal Occluder Device / Q000009:adverse effects / Q000592:standards; D060205:Therapeutic Occlusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Efficacy; Exclusion; Lariat; Left atrial appendage; Safety; Watchman device