Cardiac computed tomography angiography to detect residual peridevice leak after left atrial appendage occlusion with a Watchman device

Introduction Trans-catheter left atrial appendage (LAA) occlusion with a Watchman device (WM) (Boston Scientific Corp, MA, USA) is a feasible alternative to long-term anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation (AF). Cardiac computed tomography angiography (CCTA) is routinely used to asses LAA morphology and determine the size of the WM. Trans-esophageal Echocardiography (TEE) may identify minor peri-device leak (PL) that are supposed to be filled later. We sought to assess the mid term evolution of PL. Methods Implantation of a WM was attempted in 74 patients, successfully in 70. CCTA was performed u003e 45 days after implantation in 44 patients. We compared immediate results of the procedure by TEE to late results by CCTA performed u003e 1 month after implantation. Results Late CCAT was done in 44 patients, 28 male (64%), mean aged 77 years (57–92). Indications for LAA closure was bleeding in all cases, neurologic in 18 (45%), gastrointestinal in 16 (36%) and miscellaneous in 8 (18%). CHA2DS2-VASc score was 5 (3–9). Anticoagulation was contraindicated in all cases. An anti-platelet agent was given in 37 and no treatment in 7 (16%). None of these patients had had any thromboembolic event at the time of CCTA. A PL was identified by TEE at the time of implantation in 20 pts (45%) and by late CCTA in 22 pts (50%). In 17 pts with a CCTA done u003e 6 months, 7 had a PL (41%). Late PL was noted in 10 patients with (50%) and 12 patients (50%) without early PL. Conclusion Early PL seems to remain at mid-term in half of the patients. Moreover, TEE could be unable to detect PL that is identified by CCTA later in 1 case over 2. Nevertheless the clinical consequence of PL seems to be marginal in this study and the literature.