The evaluation of endothelialization observed by cardiac endoscopy after watchman device

The aim of this study is to clearly the ｍechanism of endothelialization after implanting Watchman divice and to evaluate the usefulness and safety of endoscopy system device in the structure procedure.

We enrolled 82 consecutive AF patients who had been implanted Watchman device in this study, Of these, 12 patients underwent catheter ablation, voltage mapping, and cardiac endoscopy to evaluate the morphology of the endothelium (thrombus and leak etc) and the degree of endothelialization, and 3 stages were classified according to the degree of endothelialization (stage 1; incomplete endothelialization with thrombus and leak, stage 2; the endothelialized in only some tissues or endothelialized except for the central part (hub) with leak, stage 3; completely endothelialized to the center (hub)).

Of the 12 patients who underwent cardiac endoscopy, 10 were able to be observed sufficiently and the degree of endothelialization could be evaluated (Figure). Stages 3 were frequently seen in cases where a long time had passed since implantation and in Watchman FLX cases, and two cases in particular within six months of implantation showed Stage 1, a state in which endothelialization was not complete, and thrombus and leakage were observed on the surface of the device. And the average time in cardiac endoscopy procedure was 28±12 minutes, and no complications were observed, making it a safe procedure.

Cardiac endoscopy allows easy and safe observation of the device surface, and endothelialization of the Watchman device correlated with the type of device and the time since implantation. This system may also be applicable to other structure procedures.Figure