Residual leaks after left atrial appendage occlusion

Peridevice leaks (PDL) represent a frequent finding following left atrial appendage occlusion (LAAO) procedures, despite continuous improvements in device design, implantation techniques, and imaging modalities. The detection, incidence, and clinical relevance vary widely depending on anatomical factors, patient characteristics, device type, and the imaging modality used. While transoesophageal echocardiography (TEE) remains the standard of care for post-procedural device surveillance, cardiac computed tomography angiography (CCTA) has shown higher sensitivity in identifying residual leaks. Although small PDL have often been considered clinically irrelevant, recent data suggest a potential association with increased risk of thromboembolic events. The size and location of the leak, as well as its evolution over time, appear to play a key role in determining clinical outcomes. Device selection, pre-procedural planning, and optimal procedural technique are essential in minimizing leak formation. In cases of clinically significant PDL, especially when anticoagulation is contraindicated, interventional closure using vascular plugs, embolization coils, or radiofrequency ablation has emerged as a viable strategy. However, management remains individualized and evidence from randomized studies is limited. Further research is needed to better define the prognostic implications of PDL and establish standardized diagnostic and therapeutic algorithms aimed to improve patient outcomes after LAAO.