Relationship between CT findings and cardiac events during follow-up after percutaneous left atrial appendage closure

Abstract Intorduction: Percutaneous left atrial appendage (LAA) closure has been established as a therapy for the prevention of cardioembolic events in patients with contraindications for anticoagulation or with embolic recurrences despite it. A high device permeability rate has been reported, although its clinical significance remains uncertain. Objective: To review cardiovascular events during the follow-up of patients who underwent LAA closure and analyze their potential relationship with findings on cardiac CT scans. Materials and Methods: This was a single-center retrospective study including patients who underwent percutaneous LAA closure between July 2016 and January 2025. The indications for closure, antithrombotic treatment at discharge, and follow-up events were reviewed. In a subgroup of patients, the permeability rate and incomplete LAA lobe coverage were analyzed through cardiac CT scans. Results: A total of 140 patients were analyzed. The mean age was 76.3+-7,8 years, with 37.8% being women. The closure indication was high hemorrhagic risk in 68.2% of cases and recurrent stroke in 18%. At discharge, 27.9% of patients were prescribed anticoagulation therapy, 51.2% were on dual antiplatelet therapy, and 20.9% were on monotherapy with antiplatelets. No procedural complications were observed except for one case of cardiac tamponade. Patients were followed for 24.3 ± 14.7 months. During follow-up 9 (6,4%) thrombotic events were observed, and 32 (22,9%) of patients experienced hemorrhagic events. Among those with hemorrhagic events, discharge treatment was anticoagulation in 23%, monotherapy in 30.9%, and dual antiplatelet therapy in the remaining cases. Cardiac CT scans were performed on 62,3% of patients. Of these, 95.5% of devices were normally positioned, with no associated thrombi. LAA was permeable in 62.2% of patients, and incomplete coverage of at least one lobe was observed in 38.1% of cases. Conclusion: The rate of embolic events during follow-up in patients who underwent LAA closure was low despite the high permeability rate of the device, although hemorrhagic events were frequent. Our findings support considering less aggressive antithrombotic therapies, such as monotherapy, in patients at high bleeding risk.