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ECHONOMY
Tools for Echocardiographic Calculations
Muhamed Saric, MD, PhD
New York University
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FDA Indication for Watchman LAA Occluder
The WATCHMAN Device is indicated to reduce the risk of thromboembolism
from the left atrial appendage in patients:
 | With non-valvular AF who are at increased risk for stroke and systemic
embolism based on CHADS2 or CHA2DS2-VASc scores; |
| Are deemed by their physicians to be suitable for warfarin; and |
| Have an appropriate rationale to seek a non-pharmacologic alternative
to warfarin |
Watchman Device Sizes
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| Watchman comes in 5 different sizes, 3 mm apart |
| Size is based on the device diameter |
| Available sizes 21, 24, 27, 30, 33 mm |
| Implanted Watchman should be appropriately oversized for a given LAA
diameter
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LAA Anatomic Exclusion Criteria
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| Largest LAA orifice diameter < 16.8 mm OR > 30.4 mm
That is, the largest LAA orifice size cannot be smaller the smallest
diameter required for the 21-mm Watchman and cannot be larger than the
largest diameter required for the 33-mm Watchman.
LAA diameter and depth are measured on TEE at 0, 45, 90 and 135 degrees.
The largest diameter and depth obtained from these 4 angles is then used.
At 0 degrees, measure from left coronary artery to 2 cm from tip of LAA
coumadin ridge. At other angles from top of MV annulus to 2 cm from tip of
LAA coumadin ridge.
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| LAA depth < Largest LAA orifice diameter
That is, a patient's LAA cannot be too shallow.
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| The depth of the secondary LAA lobe (if present) from the LAA
orifice plane < 1 cm
That is, the secondary lobe cannot be too close to the LAA orifice.
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| Presence of intracardiac thrombus or LAA dense smoke |
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Other Exclusion Criteria
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| Atrial septal aneurysm excursion distance > 15 mm |
| Atrial septal aneurysm length > 15 mm
That is, atrial septal aneurysm may be considered an indication for
anticoagulation even if LAA is excluded.
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| Large interatrial shunt
This is a semi-quantitative criterion; no specific definition for a large
shunt on color Doppler or after agitated saline injection is given.
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| Mobile aortic plaque > 4 mm
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| Mitral stenosis (MV area < 1.5 cm2)
That is, the patient cannot have significant mitral stenosis.
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| Pericardial effusion with thickness > 2 mm
That is, a patient cannot have more than a trivial pericardial effusion). |
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Watchman Device Sizes & Compression Values
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Compressed Diameters |
| Watchman Diameter |
Minimum |
Maximum |
| 21 |
16.8 |
19.3 |
| 24 |
19.2 |
22.1 |
| 27 |
21.6 |
24.8 |
| 30 |
24.0 |
27.6 |
| 33 |
26.4 |
30.4 |
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Medical Therapy Post Watchman Implantation
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| First 6 weeks - Warfarin or NOAC |
| From 7th week to 6 month - Dual antiplatelet therapy |
| After 6 months - Aspirin for life
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Watchman Screening Sheet
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