Peri-device leakage not CHA2DS2-VASc is associated with post-left atrial appendage closure cardiovascular event

Pang-Shuo Huang; Fu-Chun Chiu; Hsiao-Liang Cheng; Jung-Cheng Hsu; Su-Kiat Chua; Chun-Yuan Chu; Ting-Tse Lin; Jien-Jiun Chen; Chia-Ti Tsai

doi:10.1016/j.jstrokecerebrovasdis.2022.106688

Peri-device leakage not CHA2DS2-VASc is associated with post-left atrial appendage closure cardiovascular event

J Stroke Cerebrovasc Dis. 2022 Nov;31(11):106688. doi: 10.1016/j.jstrokecerebrovasdis.2022.106688. Epub 2022 Sep 10.

Authors

Pang-Shuo Huang¹, Fu-Chun Chiu¹, Hsiao-Liang Cheng², Jung-Cheng Hsu³, Su-Kiat Chua⁴, Chun-Yuan Chu⁵, Ting-Tse Lin⁶, Jien-Jiun Chen¹, Chia-Ti Tsai⁷

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Ling Branch, Dou-Liu City, Taiwan.
² Department of Anesthesiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
³ Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial hospital, New Taipei City, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
⁵ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial, Kaohsiung Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan.
⁷ Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: cttsai1999@gmail.com.

PMID: 36095860
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106688

Abstract

Objective: In patients with non-valvular atrial fibrillation (NVAF), the left atrial appendage occluder (LAAO) is an alternative treatment for stroke prevention. However, thromboembolic event still occur, and the predictors are unknown.

Methods: The first Asian long-term follow-up study consisted of 308 patients with mean age 71.9±9.5 years, mean CHA₂DS₂-VASc 4.1 ± 1.8 since 2013. Primary outcome was defined as any type of ischemic stroke/transient ischemic attack (TIA), systemic embolization and cardiovascular death.

Results: There was no procedural-related TIA or stroke. After a mean follow-up of 38±16 months, the ischemic stroke/TIA rate was 1.9 and cardiovascular death rate 0.3 per 100 patient-year. The rate of peri-device leak (PDL) was 11.9% and device-related thrombus (DRT) 2.6%. In the multivariable analyses, PDL was the only independent predictor of stroke/TIA (hazard ratio 5.5, p=0.008). CHA₂DS₂-VASc score, prior history of stroke, DRT and post-procedural anti-thrombotic regimen/duration were not associated with outcomes. Implantation of Watchman was associated with PDL (odds ratio 4.35, p=0.001).

Conclusions: PDL is the only independent predictor of post-LAAO stroke. The risk of stroke for patients with NVAF may be controllable after LAA is occluded, because PDL is preventable and treatable.

Keywords: Left atrial appendage occluder; Peri-device leak; Stroke; Taiwan; Thrombus on device.

MeSH terms

Aged
Aged, 80 and over
Atrial Appendage* / diagnostic imaging
Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / therapy
Follow-Up Studies
Humans
Ischemic Attack, Transient* / diagnosis
Ischemic Attack, Transient* / etiology
Ischemic Attack, Transient* / prevention & control
Ischemic Stroke*
Middle Aged
Stroke* / diagnosis
Stroke* / etiology
Stroke* / prevention & control
Thrombosis* / complications
Treatment Outcome