Does peri-device leak after left atrial appendage closure impact patient outcome?

Background Limited studies reported the rate and clinical impact of peri-device leaks (PDL) after percutaneous left atrial appendage closure (LAAC). Method All consecutive patients admitted for LAAC between November 2011 and October 2016 ( n  = 83) were prospectively enrolled. LAAC was performed under sedation using fluoroscopy and trans-esophageal echocardiography (TEE) monitoring. The follow-up included clinical, TEE and/or cardiac computed tomography angiography (CCTA). PDL was defined by the presence of contrast within the LAA on CCTA, and MACE included stroke, device-related thrombosis and cardiovascular death. LAAC failures ( n  = 3) and patients without imaging during follow-up were excluded ( n  = 10). Results Overall, 70 patients (mean age 75 ± 8 years, mean CHA2DS2-VASc = 4.4 ± 1.5 and mean HAS-BLED 3.4 ± 1.1) were implanted using Amplatzer Cardiac Plug ( n  = 24), Amulet ( n  = 32) or Watchman devices ( n  = 14). Indications were stroke recurrence under optimal treatment ( n  = 7) or contraindication to anticoagulation ( n  = 63). After LAAC, patients with a contraindication to anticoagulation received antiplatelet therapy alone (aspirin alone, n  = 33). On CCTA at 3, 6 and 12 months, PDL was observed respectively in 70% (46/66), 64% (27/42) and 50% (13/26) of patients. Patients with PDL had a larger LAA diameter (21 ± 3 mm vs. 18 ± 3 mm, P  = 0.01) and a lower prosthesis compression (13 ± 7% vs. 9 ± 7%, P  = 0.02). During follow-up (median 261 days [147–399]), MACE were observed in 7.1% of patients including 2 strokes, 2 device-related thrombosis, and 1 cardiovascular death. The presence of a PDL was not associated with MACE. Conclusion PDL is frequently observed (u003e 50%) after LAAC and tends to decrease over the time. No association is observed between PDL and MACE.