Incidence, Characteristics and Management of Persistent Peri-Device Flow after Percutaneous Left Atrial Appendage Occlusion

Abstract

ABSTRACT Background : Severe peri-device leaks after left atrial appendage (LAA) occlusion requires continuation of life-long oral anticoagulation. However, the majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics, and management of peri-device leak after LAA occlusion are scarce. Methods : We assessed the incidence of peri-device leak, its characteristics, and their management outcomes in 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018. Results : Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5 ± 4.3 vs. 19.8 ± 3.7 mm, p < 0.001), and more sub-optimal deployments (100% vs. 26.7%, p < 0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications. Conclusions : Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.