Evolution of Leak in Left Atrial Appendage Closure

Atrial fibrillation is common in elderly people and is associated with a higher risk of ischemic stroke. Left atrial appendage occlusion (LAAO) is a valid strategy, especially in patients at high risk of bleeding.

El cierre de orejuela es seguro con los nuevos dispositivos

The presence of peridevice leak (PDL) has been linked to stroke, although some analyses, such as the PROTEC-AF Study, suggest that when these leaks are <5 mm, as assessed by transesophageal echocardiography, they are not related to adverse events.

Researchers examined 519 patients who underwent LAAO with WATCHMAN 2.5. These subjects underwent angiotomography at 3 months to detect leaks. Of these, 271 showed no evidence of PDL, while 248 showed some degree of PDL.

Peridevice leaks were classified as mild (>0 to ≤3 mm), moderate (>3 to ≤5 mm), and severe (>5 mm).

There were no significant differences between the groups; the mean age was 70 years; 53% of patients were men, 46% had atrial fibrillation, 76% had hypertension, 25% had diabetes, 45% had coronary artery disease, and 50% had heart failure. Ejection fraction was 62%, and the left atrial diameter was 42 mm.

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The CHA2DS2-VASc score was 3.7 ± 1.5, and the HAS-BLED score was 2.1 ± 0.9.

After 6 years of follow-up, the presence of PDL was associated with an increased risk of stroke/transient ischemic accident (TIA) (6.5% vs. 1.8%; log-rank P=0.005), all-cause mortality (3.6% vs. 1.1%; log-rank P=0.048), and major adverse events (11.3% vs. 3.3%; log-rank P<0.001) compared with those without PDL.

The presence of severe PDL was associated with disabling or fatal stroke, but not in the case of mild or moderate leak (22.2% vs. 0.6%; P<0.001).

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Researchers analyzed patients who did not present PDL and also the degree of PDL; its absence was associated with a lower incidence of stroke/TIA, cardiovascular death, and major events.

Age and discontinuation of antiplatelet therapy at 6 months were independent predictors of stroke, TIA, and major events.


Left atrial appendage patency, as assessed by angiotomography at 3 months after LAAO, was associated with unfavorable outcomes in patients with atrial fibrillation after WATCHMAN 2.5 device implantation.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Prognostic Impact of Left Atrial Appendage  Patency After Device Closure. 

Reference: Mu Chen , et al. Circ Cardiovasc Interv. 2024;17:e013579. DOI: 10.1161/CIRCINTERVENTIONS.123.013579. 

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