Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs. Issue 6 (1st November 2020)

• Record Type: Journal Article
• Authors: Albaghdadi, Mazen; Kadlec, Andrew; Adler, Andrew; Siddiqui, Usman; Romanov, Alexander; Kuck, Karl-Heinz; Sievert, Horst; Leon, Martin B.; Vahl, Torsten
• Is Part Of: Structural heart. Volume 4:Issue 6(2020)
• Page Start: 475
• Page End: 481
• Publication Date: 2020-11-01
• Subjects: left atrial appendage occlusion (LAAO) -- peri-device leak (PDL) -- imaging; Heart -- Diseases -- Periodicals; Congenital heart disease -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular Diseases; Cardiovascular system -- Diseases; Congenital heart disease; Heart -- Diseases; Periodicals; 616.12
• DOI: 10.1080/24748706.2020.1817642
• Languages: English
• ISSNs: 2474-8706

Abstract

ABSTRACT: Oral anticoagulation reduces the ischemic stroke risk in patients with nonvalvular atrial fibrillation (NVAF) but inherently increases the bleeding risk. Percutaneous left atrial appendage occlusion (LAAO) offers an alternative to long-term anticoagulation in patients at risk for cardioembolic events due to underlying atrial fibrillation. Although long-term clinical data remain limited, percutaneous LAAO appears to be a safe and effective means of reducing hemorrhagic stroke and non-procedural-related bleeding events compared to warfarin. Incomplete closure of the LAA resulting in a peri-device leak (PDL) is common after interventions targeting the LAA and has been variably associated with an increased risk of embolic stroke in patients following LAAO. However, the clinical significance of PDL remains unclear, in part, due to variability in the definitions used for PDL, modalities used for the detection of PDL, and the confounding impact of continuing therapeutic anticoagulation in patients found to have PDL on surveillance imaging. In the current review, we examine the association of PDL with ischemic stroke and systemic embolization and explore mechanistic considerations in the development of PDL as they pertain to the unmet need for improving the diagnostic assessment of PDL from an anatomic and physiologic perspective.