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Updated: Jul 23, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
The Effect of Peri-Device Leaks on Ischaemic Stroke/Transient Ischaemic Attack/Systemic Embolism after Left Atrial
Yin-Ge He1, Shao-Hua Yang2, Liang Xu2
1Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China, 1206695426@qq.com.
Insights
Peri-device leaks (PDLs) detected by transesophageal echocardiography increase embolic risk after left atrial appendage closure (LAAC). Cardiac CT angiography did not show this association, highlighting imaging differences in PDL assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Left atrial appendage closure (LAAC) is a key strategy for preventing embolic events in non-valvular atrial fibrillation.
- Peri-device leaks (PDLs) are potential complications of LAAC, with ongoing debate about their clinical significance.
- Understanding the link between PDLs and embolic events is crucial for patient management.
Conclusions:
- TEE-detected PDLs are linked to an increased risk of embolic events post-LAAC.
- CCTA, which detects more PDLs, did not show an association with embolic events, suggesting potential over-detection of insignificant leaks.
- Future research using CCTA may clarify the relationship between PDL size and embolic risk.
Background:
Left atrial appendage closure (LAAC) is a safe and effective method for preventing embolic events in patients with non-valvular atrial fibrillation. However, peri-device leaks (PDLs) are sometimes unavoidable. Controversy exists regarding whether PDLs lead to embolic events.
Objectives:
This study aimed to explore the association between PDLs and embolic events, including ischaemic stroke, transient ischaemic attacks (TIAs), and systemic embolism (SE).
Methods:
We conducted a systematic search of the PubMed, Web of Science, MEDLINE, and Cochrane Library databases for studies published up to September 25, 2022, to compare the rate of ischaemic stroke/TIA/SE between the PDL group and the non-PDL group after LAAC.
Results:
Thirteen studies comprising 54,405 patients were included in the meta-analysis. The PDL group detected by transoesophageal echocardiography (TEE) had a significantly higher rate of ischaemic stroke/TIA/SE than the non-PDL group (OR: 1.20, 95% CI: 1.08-1.33, p = 0.0009). However, no difference in ischaemic stroke/TIA/SE was found between the PDL and non-PDL subgroups of the cardiac computed tomography angiography (CCTA) group (OR: 1.12, 95% CI: 0.51-2.50, p = 0.77). CCTA and TEE showed different rates of PDL detection, with the CCTA group having a higher rate of PDL detection (p < 0.0001), especially for trivial leaks.
Conclusions:
PDL detected by TEE increases the risk of embolic events after LAAC. However, no association was found between PDL and ischaemic stroke/TIA/SE in the CCTA group, which showed a higher rate of PDL detection than TEE, particularly for trivial leaks. In the future, CCTA may be used to explore the relationship between PDL size and ischaemic stroke/TIA/SE.
