94% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Structural Interventional Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1464567
This article is part of the Research Topic Advance in the Etiology, Imaging Diagnosis and Interventional Treatment of Cardiogenic Stroke View all articles
A novel method using body surface steel ball as a reference scale to measure the left atrial appendage for optimal selection of Watchman device
Provisionally accepted- Ningbo First Hospital, Ningbo, China
Background Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke prevention in non-valvularatrial fibrillation (AF). Selecting the appropriate size of Watchman device is very important intra-procedure. Objective We investigated the efficacy and safety of using the novel "steel ball method" compared to using the traditional "sheath method" and TEE during procedure of LAAC with Watchman device in AF patients.Methods Patients with atrial fibrillation who underwent LAAC with Watchman device from January 2018 to December 2021 were retrospectively analyzed. A 10-mm-diameter steel ball was placed on patient's body surface at the pulmonary valve auscultation zone before procedure. The maximum LAA ostium diameter, maximum LAA depth, and 1st sheath marker band length were measured under X-ray fluoroscopy, using the delivery sheath, pigtail sheath, and steel ball as references, respectively. The maximum LAA ostium diameter and maximum LAA depth were also measured by transesophageal echocardiography (TEE). All Watchman devices were selected based on the measurement of LAA by "steel ball method". Eventually a total of 169 patients underwent Watchman device implantation successfully were enrolled. The mean maximum LAA ostium diameter measured in steel ball group (24.73 ± 3.39 mm) was significantly higher than that in delivery sheath group (20.04 ± 3.24 mm, p<0.001) and pigtail sheath group (22.48 ± 3.74 mm, p<0.001), while was not significantly different from the results measured by TEE (24.39 ± 4.13 mm, p=0.176). The difference between 1st sheath marker band length measured in steel ball group and the true length (21 mm) was 0.29 ± 0.61 mm, which was significantly less than that in delivery sheath group (4.22 ± 1.42 mm) and pigtail sheath group (2.17 ± 1.90 mm) (both p < 0.001). Finally, the success rate of Watchman device implantation is 98.8%, with no serious intra‐procedure complication. 98.8% and 97.0% of patients had either no or slight (≤3 mm) PDL with immediate and 45 days post-procedural TEE scans, respectively.In LAAC, the novel method using body surface steel ball as a reference scale to measure the left atrial appendage and guide the selection of Watchman device is accurate, effective, and safe.
Keywords: Left atrial appendage closure, Watchman, Steel ball, sheath, TEE
Received: 14 Jul 2024; Accepted: 26 Feb 2025.
Copyright: © 2025 Jin, Feng, Du, Wang, Yu, Fu, Shen and Chu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Huimin Chu, Ningbo First Hospital, Ningbo, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.