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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT: A Meta-Analysis
Xander Jacquemyn1, Michel Pompeu Sá2, Kasper Korsholm3
1Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Residual leaks after left atrial appendage occlusion (LAAO) are common. Left atrial appendage patency significantly increases thromboembolism risk, suggesting CT-detected leaks are clinically significant.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Residual leaks are a frequent complication following left atrial appendage occlusion (LAAO).
- The clinical significance of these residual leaks requires further elucidation.
Purpose of the Study:
- To systematically evaluate the prognostic implications of residual left atrial appendage (LAA) patency and peridevice leaks (PDLs).
- To assess the association of LAA patency and PDLs detected by cardiac computed tomography (CT) with thromboembolism risk post-LAAO.
Main Methods:
- A meta-analysis of 17 studies including 2,036 patients was performed.
- Bayesian statistical methods were employed to assess the probability of increased risks associated with residual leaks.
Main Results:
- Left atrial appendage patency was significantly associated with a nearly 2-fold increased odds ratio (OR) of thromboembolism (pooled OR: 1.87).
- Peridevice leaks (PDLs) showed a trend towards increased risk but did not reach statistical significance (pooled OR: 1.50).
- The posterior probability of a positive absolute risk difference for LAA patency was 98.5%.
Conclusions:
- Left atrial appendage patency and PDLs detected by CT following LAAO may be linked to an elevated risk of thromboembolism.
- These findings suggest that residual leaks identified by CT are clinically significant and warrant careful consideration.
Background:
Residual leaks are common after left atrial appendage occlusion (LAAO).
Objectives:
The authors aimed to systematically evaluate the prognostic implications of residual left atrial appendage (LAA) patency and peridevice leaks (PDLs) detected by cardiac computed tomography (CT) following LAAO.
Methods:
The authors used traditional meta-analytical methods and a Bayesian framework to assess the probability of increased risks associated with these residual leaks.
Results:
Seventeen studies encompassing 2,036 patients met the inclusion criteria. During follow-up, the presence of any LAA patency was significantly associated with an almost 2-fold increased OR of thromboembolism (pooled OR: 1.87, 95% CI: 1.08-3.24), corresponding to 28 (95% CI: 3-68) additional events per 1,000 patients. Although PDL showed a similar trend, it was not significantly associated with increased thromboembolism risk (pooled OR: 1.50, 95% CI: 0.85-2.65). For thromboembolism with LAA patency, under a noninformative prior, the mean logOR was 0.59 (95% credible interval [Crl]: 0.06-1.15), and translated median OR of 1.87 (95% CrI: 1.06-3.14) and a mean absolute risk difference (ARD) of 2.8% (95% CrI: 0.2%-6.8%). The posterior probability of ARD >0% was 98.5%. For any PDL, the mean logOR was 0.38 (95% CrI: -0.22 to 0.95), with a median OR of 1.53 (95% CrI: 0.80-2.59) and mean ARD of 1.9% (95% CrI: -0.7% to 5.4%). The posterior probability of ARD >0% was 89.8%.
Conclusions:
LAA patency and PDL identified by CT may be associated with an increased risk of thromboembolism. These findings indicate that residual leaks detected by CT may be clinically significant and should not be regarded as benign.
