Management of peri-device leaks after left atrial appendage occlusion requires understanding the mechanisms of incomplete closure and associated thromboembolic risks to guide clinical recommendations.
This review synthesizes current understanding and provides management recommendations for the clinical dilemma of peri-device leaks following left atrial appendage occlusion.
Left atrial appendage (LAA) closure for stroke prevention in the setting of non-valvular atrial fibrillation is an alternative to oral anticoagulation in patients with increased bleeding risk. It allows similar reduction in thromboembolic events, in particular stroke, compared to warfarin. A common clinical dilemma is the management of patients with peri-device leak after LAA occlusion. This has been documented in both percutaneous as well as surgical approaches. The specific definitions of leak severity, and the longer-term clinical implications are poorly understood. Here we review the mechanisms of incomplete occlusion for the different percutaneous closure devices, the data regarding thromboembolic risk in patients with incomplete appendage closure for both percutaneous and surgical strategies, and provide recommendations for management in these patients.
Raphael et al. (Wed,) conducted a review in Non-valvular atrial fibrillation with peri-device leak after LAA occlusion. Management of peri-device leak after LAA occlusion was evaluated. Management of peri-device leaks after left atrial appendage occlusion requires understanding the mechanisms of incomplete closure and associated thromboembolic risks to guide clinical recommendations.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: