Impact of left atrial appendage (LAA) morphology on intraprocedural outcomes for watchman device implantation

Introduction: Left a trial appendage (LAA) is a very heterogeneous structure and has traditionally been classified into 4 different morphologies: the cauliflower/broccoli, cactus, windsock and chicken wing. Hypothesis: Left a trial appendage (LAA) is a very heterogeneous structure and has traditionally been classified into 4 different morphologies: the cauliflower/broccoli, cactus, windsock and chicken wing. Methods: A retrospective review of the institutional database was conducted to identify patients who had undergone watchman device implantation. Data regarding LAA morphology, pre and post implant LAA dimensions and other procedure related variables were collected and analyzed. Results: A total of 133 patients were identified (table 1). The most common morphology was windsock 54%, (n = 72/133) followed by chicken wing in 19% (n=33/173), nonspecific in 12% (n = 20/133) and Broccoli in 6% (n = 8/133). Average length and width of different LAA morphologies were not statistically different. Minimum and average mean compression was lower in chicken wing morphology compared to other morphologies (p-value 0.003 and 0.013). Success rate in patients with broccoli morphology was lower compared to the rest of morphologies (p = 0.004).There is no statistically significant difference in number of partial retrievals, number of devices used and procedure duration among different LAA morphologies. Conclusion: Chicken wing and broccoli shapes are challenging LAA morphologies for Watchman device procedures with significant impact on compression ratio and implantation success rate, respectively.