Abstract
Left atrial appendage closure (LAAC) with WM FLX is recommended for AF patients with high CHADS2VASC score who are intolerant to oral anticoagulants or at high risk of bleeding. LAAC can be challenging in some patients due to anatomy of the LAA. Even in patients with successful WM FLX deployment, some may develop PDL in the future. The factors resulting in development of PDL are not well understood. It is possible that LAA ostial remodeling is related to Device-LAA wall interactions and regional stress that is unevenly distributed. To study the relationship of Transesophageal Echo (TEE) guided measurements of LAA ostium post WM FLX device implantation with subsequent development of PDL. We identified all patients in past 2 years who underwent WM FLX device placement with reported new PDL on 6 week follow up TEE and compared it with a historical group who did not develop PDL. We evaluated the size of the LAA ostium measured by TEE before and immediately post WM FLX implant. We hypothesized that the patients that develop PDL may have unequal compression of the WM device in different axes (Oval instead of even circular compression) leading to remodeling that favors PDL development. Of 502 WM implants, PDL was reported in 57 patients at 6 week TEE with a incidence of 11.3%. We evaluated 133 patients who did not develop PDL as a control group. TEE measurements of LAA ostium were taken before and after WM FLX implantation in standard 0,45,90 and 135 degree views. The size of WM device used was not significantly different in PDL vs No-PDL group (Table 1). The difference between the axes with Minimum and Maximum compression- Delta Min-Max (Oval Index) was significantly higher in the PDL group compared to No-PDL group (3.03 vs 1.84 mm, p-value of 0.03). When adjusted for WM size, the difference in compression ratios (Min-Max axes) remained significantly higher in the PDL group compared to No PDL group (10.07% vs 7.01%, p-value of 0.004) Our analysis supports the hypothesis that an increased Oval Index and unequal compression post WM FLX implantation is associated with PDL development at 6 weeks. This has implications for WM FLX device implantation and suggests consideration of the Oval Index prior to device release. Further analysis is required to evaluate this and other factors involved in development of PDL post WM FLX.
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