Long-term cardiac computed tomography follow-up after left atrial appendage occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Left atrial appendage occlusion (LAAO) is an increasingly utilized procedure.
• Long-term imaging data following LAAO are limited.
• The Amplatzer Amulet device is commonly used for LAAO.

Purpose of the Study:

• To evaluate the safety and durability of the Amplatzer Amulet device.
• To assess device performance more than 4 years after LAAO.
• To analyze long-term left atrial appendage sealing and peridevice leakage.

Main Methods:

• Prospective observational cohort study of 52 patients.
• Cardiac computed tomography (CT) scans at 2 months, 12 months, and >4 years post-LAAO.
• Primary outcome: LAA sealing and peridevice leakage (PDL) grading.
• Secondary outcomes: hypoattenuated thickening, device-related thrombosis, and device durability.

Main Results:

• Stable complete occlusion rates (33-37%) and moderate leaks (G2, 48-52%) observed over time.
• Minor leaks (G1) decreased, while significant leaks (G3) increased from 2% to 12%.
• No device-related thrombosis (DRT) was detected, and device integrity remained intact.
• Left atrial volume showed a trend of increase over the follow-up period.

Conclusions:

• The Amplatzer Amulet device demonstrates stable LAA sealing and excellent long-term durability.
• Procedural success is crucial for preventing peridevice leakage.
• Progression of PDL in a few patients may be associated with left atrial remodeling.
• Further research with larger cohorts is recommended.