Radiofrequency Energy Applications Targeting Significant Residual Leaks After Watchman Implantation: A Prospective, Multicenter Experience

Domenico G. Della Rocca, Ghulam Murtaza, Luigi Di Biase, Krishna Akella, Subramaniam C. Krishnan, Michele Magnocavallo, Sanghamitra Mohanty, Carola Gianni, Chintan Trivedi, Carlo Lavalle, Giovanni B. Forleo, Veronica N. Natale, Nicola Tarantino, Jorge Romero, Rakesh Gopinathannair, Philip J. Patel, Mohamed Bassiouny, Armando Del Prete, Amin Al-Ahmad, J. David BurkhardtG. Joseph Gallinghouse, Javier E. Sanchez, Shephal K. Doshi, Rodney P. Horton, Dhanunjaya Lakkireddy, Andrea Natale

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objectives: The aim of this study was to evaluate the efficacy of radiofrequency (RF) energy applications targeting the atrial side of a significant residual leak in patients with acute and chronic evidence of incomplete percutaneous left atrial appendage (LAA) occlusion. Background: RF applications have been proved to prevent recanalization of intracranial aneurysms after coil embolization, thereby favoring complete sealing. From a mechanistic standpoint, in vitro and in vivo experiments have demonstrated that RF promotes collagen deposition and tissue retraction. Methods: Forty-three patients (mean age 75 ± 7 years mean CHA2DS2-VASc score 4.6 ± 1.4, mean HAS-BLED score 4.0 ± 1.1) with residual leaks ≥4 mm after Watchman implantation were enrolled. Procedural success was defined as complete LAA occlusion or presence of a mild or minimal (1- to 2-mm) peridevice leak on follow-up transesophageal echocardiography (TEE), which was performed approximately 45 days after the procedure. Results: RF-based leak closure was performed acutely after Watchman implantation in 19 patients (44.2%) or scheduled after evidence of significant leaks on follow-up TEE in 24 others (55.8%). The median leak size was 5 mm (range: 4-7 mm). On average, 18 ± 7 RF applications per patient (mean maximum contact force 16 ± 3 g, mean power 44 ± 2 W, mean RF time 5.1 ± 2.5 minutes) were performed targeting the atrial edge of the leak. Post-RF median leak size was 0 mm (range: 0-1 mm). A very low rate (2.3% [n = 1]) of major periprocedural complications was observed. Follow-up TEE revealed complete LAA sealing in 23 patients (53.5%) and negligible residual leaks in 15 (34.9%). Conclusions: RF applications targeting the atrial edge of a significant peri-Watchman leak may promote LAA sealing via tissue remodeling, without increasing complications.

Original languageEnglish (US)
Pages (from-to)1573-1584
Number of pages12
JournalJACC: Clinical Electrophysiology
Issue number12
StatePublished - Dec 2021


  • Watchman
  • atrial fibrillation
  • leak
  • left atrial appendage
  • radiofrequency
  • stroke
  • transesophageal echocardiogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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