Key result
Lobe-LAA axis misalignment was the only independent predictor of residual device patency following left atrial appendage occlusion (HR 38.3).
Why the study?
Cardiac computed tomography angiography appears appropriate for device surveillance after LAAO, but available clinical experience is limited.
Does residual LAA patency or device-related thrombosis detected on CCTA increase the risk of adverse clinical events in patients with non-valvular AF after LAAO?
Observational (n=137)
No
Does residual LAA patency or device-related thrombosis detected on CCTA increase the risk of adverse clinical events in patients with non-valvular AF after LAAO?
Hazard Ratio: 38.3 (95% CI 13.6–107)
p-value: p=<0.001
Residual LAA patency on CCTA is common after LAAO with AMPLATZER devices, primarily due to proximal lobe malapposition, but does not appear to increase the risk of adverse clinical outcomes.
Residual LAA patency may not raise thromboembolic risk after LAAO; leaves open whether alignment optimization improves device success.
BACKGROUND: Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However, the available experience is limited. AIMS: The aim of this study was to determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification. METHODS: Consecutively enrolled patients who underwent LAAO with an AMPLATZER device were followed up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed. RESULTS: A total of 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3, 95% CI: 13.6-107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism. Any degree of hypo-attenuated thickening (HAT) was found in 16.8% (n=23) of patients, of whom 16 (11.7%) had low-grade HAT and 7 (5.1%) had high-grade HAT or definite DRT. Complete sealing was associated with increased rates of low-grade HAT. CONCLUSIONS: LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability. Patency was not associated with adverse outcomes. Low-grade HAT may be related to a benign, uneventful, endothelialisation process favoured by complete LAAO.
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A 2021 study conducted an observational in Non-valvular atrial fibrillation (n=137). Lobe-LAA axis misalignment vs. Coaxial alignment was evaluated on Device patency after LAAO (HR 38.3, 95% CI 13.6-107.0, p=<0.001). Lobe-LAA axis misalignment was the only independent predictor of residual device patency following left atrial appendage occlusion (HR 38.3).
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