The WATCHMAN® Left Atrial Appendage Closure Device
The WATCHMAN Left Atrial Appendage Closure Device (Boston Scientific) is a novel technology developed in the United States and currently implanted in about 30 countries worldwide. This device is investigational in use in the United States and is used in patients with non-valvular atrial fibrillation to occlude the left atrial appendage (LAA).
The LAA is a common source of thrombus, which can lead to stroke. The stroke risk for patients with atrial fibrillation is significantly higher than for the normal public. The WATCHMAN procedure is performed in a cardiology catheter or electrophysiology suite, or hybrid surgical / Cath lab suite.
Use of echocardiography, fluoroscopy, and angiography combine to provide imaging guidance throughout the closure device implant. Echo imaging via TEE is key to the success of this procedure. And, echo imaging and defined measurements of the left atrial appendage is a specific skill set necessary for safe and effective implants.
Creating training programs to use WATCHMAN technology
In creating training programs for new users of the WATCHMAN technology, a robust training program is required for new physician implanters, echo physicians who support these implants, as well as for clinical and sales team members working with this closure technology.
We have worked closely with the HeartWorks team to incorporate this echo simulation training into our WATCHMAN training programs. The current TEE simulation with HeartWorks allowed us to reinforce the imaging planes used in TEE. This portion has been especially useful for interventional cardiologists and electrophysiologists who do not routinely use TEE in their daily practices. The TEE simulation has also been helpful for the clinical and sales specialists who have been learning the WATCHMAN procedure.
A collaborative partnership
But, we also needed to find additional imaging tools to assist us in teaching the specific views needed for the left atrial appendage itself. By working side-by-side with the engineering and sales teams working within the HeartWorks group, this team was able to create simulation imaging of the LAA to meet our specific criteria for WATCHMAN.
Imaging simulation for procedural steps, measurements of the LAA at both ostium and length in multiple TEE planes, and device placement were created. We continue to work with HeartWorks to grow the representation of various anatomic variations of the LAA, as well as various placements of the device within the LAA. All of these image simulations are allowing us to enhance our training through hands-on and visual learning.