Combined atrial fibrillation ablation and left atrial appendage closure: Watchman vs. LAmbre devices

Abstract

BackgroundLeft atrial appendage closure (LAAC) combined with radiofrequency catheter ablation is an emerging one-stop hybrid procedure for non-valvular atrial fibrillation (AF). This study was performed to compare the efficacy and safety of the Watchman device vs. the LAmbre device for this combined procedure.MethodsTwo hundred and thirty two patients with AF who underwent the combined procedure were enrolled and divided into two subgroups depending on the device choice: the Watchman-combined group (n = 118) and the LAmbre-combined group (n = 114). The periprocedural and follow-up adverse events in both groups were documented.ResultsThe mean CHA2DS2-VASc score and HAS-BLED score in the Watchman-combined group and LAmbre-combined group were 3.7 ± 1.5 vs. 3.8 ± 1.5 and 2.5 ± 1.1 vs. 2.3 ± 1.1, respectively (all P > 0.05). Successful LAAC was achieved in all patients. The rate of major periprocedural complications and AF recurrence at 6 months post-procedure were similar between the Watchman-combined group and LAmbre-combined group (0.8 vs. 0.9%, P = 1.00; 22.0 vs. 15.8%, P = 0.23). During 2.6 ±0 .7 vs.1.6 ± 1.6 years follow-up, the rate of major clinical adverse events, including stroke and major bleeding, were comparable between the Watchman-combined group and the LAmbre-combined group (2.6 vs. 1.1% per 100 patient-years, P = 0.33). The intraprocedural peri-device leakage (PDL) rate was similar between the Watchman-combined group and the LAmbre-combined group (5.1 vs. 6.1%, P = 0.73), but the PDL rate was significantly higher at 3–6 months transesophageal echocardiography (TEE) follow-up than the intraprocedural PDL rate in both groups (21.6 vs. 5.1%; 36.6 vs. 6.1%, respectively), with a more obvious increase in minimal PDL rate in the LAmbre-combined group than the Watchman-combined group (36.6 vs. 21.6%, P < 0.05).ConclusionThe Watchman and LAmbre devices were comparable in efficacy and safety for the combined procedure. The minimal PDL rate at short-term TEE follow-up was higher in the LAmbre-combined group than the Watchman-combined group.

Twice-daily rivaroxaban after percutaneous left atrial appendage closure for atrial fibrillation

“…The patients underwent either a one-stop procedure (combined CA and LAAC) or LAAC. Catheter ablation was performed as previously described ( Ke et al, 2022 ). Antral ring electrical isolation of the left and right pulmonary veins was performed in all patients, and additional linear ablation was individualized according to requirements for persistent forms of AF or for redo ablation procedures.…”

Transcatheter Left Atrial Appendage Closure

“…Several small trials comparing LAmbre with Watchman and Amulet have suggested comparable efficacy and safety profiles, although trials with larger enrollments are needed. [23][24][25] LifeTech gained FDA approval in March 2022 for a pre-market randomized multicenter trial comparing the safety and efficacy of LAmbre against OAC. The trial is anticipated to enroll more than 3,000 patients, with more than 1,500 implantations.…”

Percutaneous Left Atrial Appendage Occlusion Therapy: Past, Present, and Future

“…US FDA approval will be necessary before wide clinical application can be achieved. Nonetheless, limited clinical comparison studies appear to suggest that the LAmbre™, Amulet™, and Watchman™ 2.5 all have high implant success rates, low risk of periprocedural adverse events, and good clinical outcomes [76,[81][82][83].…”