Table 1.

WaveCrest device features

Possible advantages

•Retractable rollout anchors with microtines, which allow separation of device positioning from anchoring and for safer repositioning. •Device material is occlusive and nonthrombogenic. •The center hub of the device retracts within the ePTFE-covered “clover,” which leaves no exposed metal on left atrium–facing surface. •Designed for distal contrast injection inside LAA to assess for device leak. •Device allows for a short landing zone. •No warfarin is required. Dual-antiplatelet therapy is used instead. •The location of device seal is along the distal margin of the device rather than the proximal margin as with the Watchman. This may better accommodate LAAs that are wide and shallow or have proximal angulations.

Possible disadvantages

•The WaveCrest delivery sheath is placed within the LAA without a pigtail catheter, theoretically posing a risk for LAA damage and pericardial effusion. •Although TEE is essential for transseptal puncture guidance, LAA sizing, and device deployment, acoustic shadowing due to the presence of air between layers of WaveCrest ePTFE fabric may partly hinder echocardiographic assessment of device seal. However, this limitation is overcome by complementary use of fluoroscopy with injections in both the left atrium and LAA.