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Journal of Interventional Cardiac Electrophysiology

Erschienen in:

06.01.2024 | REVIEWS

Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review

verfasst von: Baraa Helal, Jibran Khan, Dalia AlJayar, Mohammad Salman Khan, Mohamad S. Alabdaljabar, Zain Ul Abideen Asad, Christopher V. DeSimone, Abhishek Deshmukh

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 4/2024

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Abstract

Background

Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation.

Methods

This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management.

Results

A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3–5 mm: moderate, < 1 mm minor, or trivial. Follow up time for PDL detection was 7.15 ± 9.0 months. 33% had PDL, irrespective of PDL severity/size, and only 0.9% had PDL of greater than 5 mm. The main risk factors for PDL development included lower degree of over-sizing, lower left ventricular ejection fraction, device/LAA shape mismatch, previous radiofrequency ablation, and male sex. The most common methods to screen for PDL included transesophageal echocardiogram and cardiac CT. PDL Management approaches include Amplatzer Patent Foramen Ovale occluder, Hookless ACP, Amplatzer vascular plug II, embolic coils, and detachable vascular coils; removal or replacement of the device; and left atriotomy.

Conclusion

Following LAAC, the emergence of a PDL is a significant complication to be aware of. Current evidence suggests possible risk factors that are worth assessing in-depth. Additional research is required to assess suitable candidates, timing, and strategies to managing patients with PDL.

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Titel: Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review
verfasst von: Baraa Helal
Jibran Khan
Dalia AlJayar
Mohammad Salman Khan
Mohamad S. Alabdaljabar
Zain Ul Abideen Asad
Christopher V. DeSimone
Abhishek Deshmukh
Publikationsdatum: 06.01.2024
Verlag: Springer US
Erschienen in: Journal of Interventional Cardiac Electrophysiology / Ausgabe 4/2024
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-023-01729-z

Impact of preoperative ventricular arrhythmia on morbidity in patients receiving durable left ventricular assist device

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Cough-induced sudden acute chest pain and massive left hemothorax soon after pacemaker implantation

IMAGES IN ELECTROPHYSIOLOGY

Severe ST-segment elevation and AV block during pulsed-field ablation due to vasospastic angina — a novel observation

CASE REPORTS

The Koch triangle: terra incognita of the heart

COMMENTARY

Computed tomography–based device-sizing in Amplatzer Amulet left atrial appendage occlusion

Open Access

One shot to challenge single-shot

INVITED COMMENTARY

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Springer Medizin

Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review

Abstract

Background

Methods

Results

Conclusion

Weitere Artikel der Ausgabe 4/2024

Impact of preoperative ventricular arrhythmia on morbidity in patients receiving durable left ventricular assist device

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Severe ST-segment elevation and AV block during pulsed-field ablation due to vasospastic angina — a novel observation

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