Peridevice Leak After Left Atrial Appendage Occlusion: Incidence, Mechanisms, Clinical Impact, and Management

doi:10.1016/j.jcin.2022.12.006

JACC: Cardiovascular Interventions

Volume 16, Issue 6, 27 March 2023, Pages 627-642

https://doi.org/10.1016/j.jcin.2022.12.006 Get rights and content

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Highlights

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PDL after LAAO are common and are associated with an increased risk of thromboembolic events.
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Comprehensive assessment of a PDL should consider not only its dimensions but also its potential mechanisms.
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Closure of PDL can be performed using plugs, occluders, coils, or radiofrequency ablation. However, long-term data on these approaches are limited.
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Novel devices, steerable sheaths, and computational simulation may aid in mitigating the risk of PDL in the future.

Abstract

Left atrial appendage occlusion is an increasingly adopted stroke prevention strategy in patients with atrial fibrillation. However, peridevice leaks after the procedure are not infrequent and have recently been shown to confer a higher risk for subsequent ischemic events. In this paper, the authors review the available research on the frequency, mechanisms, clinical significance, and management of peridevice leak after percutaneous left atrial appendage occlusion.

Central Illustration

Key Words

anticoagulation

atrial fibrillation

left atrial appendage occlusion

stroke

Abbreviations and Acronyms

atrial fibrillation

computed tomography

LAA

left atrial appendage

LAAO

left atrial appendage occlusion

NCDR

National Cardiovascular Data Registry

PDL

peridevice leak

TEE

transesophageal echocardiography

Cited by (0)

: Ignacios Amat-Santos, MD, served as Guest Editor for this paper.

: Lars Søndergaard, MD, served as Guest Editor-in-Chief for this paper.

: The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.