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Updated: Sep 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with
Kasper Korsholm1, Jesper M Jensen1, Bjarne L Nørgaard1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Peridevice leak (PDL) after left atrial appendage occlusion (LAAO) is common and persists one year post-procedure. While not significantly linked to adverse events in this study, further research is needed.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Peridevice leak (PDL) is a potential complication following LAAO, but its natural history is not well understood.
Purpose of the Study:
- To investigate the changes in PDL from 2 to 12 months after LAAO using cardiac computed tomography (CT).
- To assess the association between persistent PDL and clinical outcomes.
Main Methods:
- Single-center observational study of 153 patients who underwent LAAO with Amplatzer devices.
- Cardiac CT imaging was performed at 2 and 12 months post-procedure.
- PDL was analyzed for frequency and size; patients were followed for ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death.
Main Results:
- PDL was frequently observed, with contrast patency decreasing from 66% at 2 months to 47% at 12 months (p < 0.001).
- PDL at the device disc was present in 67% at 2 months and 61% at 12 months (p=0.08), with no significant change in area.
- Persistent PDL was associated with permanent atrial fibrillation and a trend towards worse clinical outcomes (HR: 1.62, p=0.11).
Conclusions:
- Persistent PDL is common after LAAO with Amplatzer devices and remains relatively unchanged between 2 and 12 months.
- While not statistically significant in this study, persistent PDL warrants further investigation regarding its impact on clinical outcomes.
Background:
The natural history of peridevice leak (PDL) following left atrial appendage occlusion (LAAO) is unknown. This study sought to investigate changes of PDL from 2 until 12 months after LAAO, using cardiac computed tomography (CT), and to assess the potential association between persistent PDL and clinical outcomes METHODS: Single-center observational study of Amplatzer LAAO implants between 2010 and 2017 (n = 206). Patients with 2 and 12 months cardiac CT were included in the study (n = 153). Images were blindly analyzed. PDL was characterized by frequency and size at the device disc, lobe, and left atrial appendage contrast patency. Patients were followed for the composite outcome of ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death. Median follow up from LAAO was 3.1 (2.3-4.3) years.
Results:
Contrast patency was present in 101 (66%) and 72 (47%) (p < 0.001) at 2 and 12 months, respectively. PDL was identified at the disc in 103 (67%) patients at 2 months versus 93 (61%) at 12 months (p = 0.08), and at the lobe in 29 (19%) at both time points. PDL area at the disc did not change significantly over time, area: -8.95 mm (95% confidence interval [CI]: -18.9; 1.01) p = 0.08. Permanent atrial fibrillation was independently associated with persistent PDL. Persistent versus no PDL was associated with a 62% worse clinical outcome, however not statistically significant, hazard ratio (HR): 1.62 (95% CI: 0.9-2.93), p = 0.11.
Conclusion:
Persistent PDL was frequently observed following LAAO with Amplatzer devices. The PDL frequency and size appeared unchanged between 2 and 12 months. Persistent PDL was not significantly associated with worse clinical outcomes, yet this needs further delineation in future studies.
