Long-term transesophageal echocardiography follow-up after percutaneous left atrial appendage closure

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Percutaneous left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke risk reduction in atrial fibrillation.
• Device-related complications like peri-device leaks and thrombi are known risks, typically assessed up to 12 months post-procedure.
• Long-term data on these complications beyond one year are limited.

Purpose of the Study:

• To evaluate the incidence and characteristics of device-related complications after percutaneous left atrial appendage occlusion (LAAO) beyond the 12-month follow-up period.
• To assess the persistence and evolution of peri-device leaks and device thrombi over extended follow-up durations.

Main Methods:

• A prospective, 2-center, nonrandomized trial involving 63 patients who underwent successful LAAO at least 12 months prior.
• Structured transesophageal echocardiography (TEE) was performed for long-term assessment of peri-device leaks, device thrombi, and other device-related issues.
• Follow-up duration ranged from 1.0 to 7.5 years, with a median of 3.1 years post-implantation.

Main Results:

• The incidence of patients without detectable leaks increased significantly at long-term follow-up compared to 6-week assessments (P = .04).
• Major peri-device leaks (>5 mm) were observed in 3% of patients, and device thrombus was detected in 13%.
• Patients with device thrombus had larger 6-week peri-device leaks (median 3.0 mm vs 1.4 mm; P = .04). One of five ischemic stroke patients had a significant leak; no stroke patients had device thrombus.

Conclusions:

• Peri-device leaks and device thrombi remain potential complications during long-term follow-up after LAAO.
• The clinical significance of these late-occurring device-related complications necessitates further investigation in larger prospective studies.