LAUSR

Percutaneous left atrial appendage closure (LAAC) is recognised as an alternative to long-term anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation and contraindication to systemic oral anticoagulation. The new generation of WATCHMAN device, the WATCHMAN FLX, is designed to treat a wider range of left atrial appendage (LAA) anatomies and sizes compared to the previous iteration, the WATCHMAN 2.5. Indeed, a recent study showed that WATCHMAN FLX implantation either in patients with a prior failed attempt with WATCHMAN 2.5 or with a LAA anatomy judged to be unfavourable remains safe and highly effective [1]. However, when facing particular anatomical features or procedural challenges, the WATCHMAN 2.5 may be useful and complementary to the newest generation device. Herein, we illustrate some cases in which the use of the WATCHMAN 2.5 device facilitated procedural success despite challenging LAA anatomies.