Development of an in vitro test procedure for the characterization of left atrial appendage occluder devices

The implantation of an occluder in the left atrial appendage (LAA) is an emerging therapy for the treatment of patients suffering from atrial fibrillation and with a contraindication to oral anticoagulation. The LAA occluder (LAAO) provides a reduction of the potential risk of strokes by thromboembolism. Currently, only a few CE-approved devices are available on the market and the number of clinical trials is comparatively low. Furthermore, there is currently no standardized test method available for testing functionality of the occluder, especially for testing safe anchorage and permeability. Therefore, the aim of this study is to establish an in vitro test method to prove anchorage mechanism and permeability regarding thromboembolism of the LAAO under physiological conditions. A standardized technical and fully parameterized silicone model of a LAA, based on studies of different morphologies and sizes, was developed. The LAA model was mounted onto the left atrial chamber of a commercial pulse duplicator system to simulate physiological hemodynamic conditions. The test was performed using the Watchman device (Boston Scientific, USA; size: 31 mm). The inner implantation diameter of the LAA model was designed according to a target compression of 10% for the Watchman device in the implanted configuration. Furthermore, thrombus-like particles (n=150, d=1,7±0,05 mm) were added to represent the flushing of thrombi out of the LAA after device implantation. Within several cycles it was confirmed that no particles were washed out of the LAA model with the implanted occluder leading to a full protection against thromboembolism. It could also be shown that the occluder is firmly anchored in the LAA. Pressure measurements with sensors in the left atrium and in the LAA distal to the occluder could also show that the occluder has no influence on the pressure conditions in the LAA.