New Research Paper
Focus on Left Atrial Appendage Occlusion
Evaluation of Multimodality LAA Leak Closure Methods Following Incomplete Occlusion: The LAA Leak Study

https://doi.org/10.1016/j.jcin.2022.08.034Get rights and content
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Abstract

Background

Incomplete left atrial appendage (LAA) closure is an evolving topic of clinical significance and thromboembolic potential, with recent long-term studies suggesting lower cutoffs for relevant leak size.

Objectives

The aim of this prospective observational study was to assess 3 different closure techniques for persistent peridevice leaks after incomplete LAA closure and compare their efficacy and safety outcomes.

Methods

We studied 160 patients (mean age 72 ± 9 years; 71% men) who underwent 1 of the 3 available modalities (detachable embolization coils, vascular plugs or septal occluders, and radiofrequency ablation) for residual central or eccentric leak closure. Both acute postprocedural success (closure or <1-mm leak at the end of the procedure) and closure at 1-year follow-up transesophageal echocardiography imaging were evaluated.

Results

Of 160 patients, 0.6%, 41.3%, and 58.1% had mild (1-2 mm), moderate (3-5 mm), and severe (≥5 mm) leaks, respectively. Baseline LAA closure type was 72.5% Watchman FLX, 16.3% Lariat, 5.6% surgical ligation, 1.9% AtriClip, and 1.9% Amulet. Successful closure (0- or <1-mm leak) was seen in 100% of patients in all cohorts following intervention, with overall complete closure (0-1 mm) or mild or minimal leaks (1-2 mm) on 1-year follow-up transesophageal echocardiography seen in 100% of the atrial septal occluder or vascular plug cohort, 85.9% of the coil cohort, and 83.3% of the radiofrequency ablation cohort (P < 0.001). Two patients (1.3%) experienced cardiac tamponade, and there were no deaths or other complications.

Conclusions

Peridevice leaks can safely and effectively be closed using 3 different modalities depending on size and location.

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Key Words

atrial fibrillation
central leaks
leak closure
left atrial appendage
left atrial appendage closure
peridevice leaks

Abbreviations and Acronyms

AF
atrial fibrillation
ASO
atrial septal occluder
CRIC
clinically relevant incomplete closure
CVA
cerebrovascular accident
ICE
intracardiac echocardiography
IDL
intradevice leak
LAA
left atrial appendage
LAAC
left atrial appendage closure
PDL
peridevice leak
RF
radiofrequency
RFA
radiofrequency ablation
STE
systemic thromboembolism
TEE
transesophageal echocardiography
TIA
transient ischemic attack
VP
vascular plug

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