Evaluation of Multimodality LAA Leak Closure Methods Following Incomplete Occlusion: The LAA Leak Study

Rishi Charate, Adnan Ahmed, Domenico G. Della Rocca, Stephen Bloom, Jalaj Garg, Naga Venkata K. Pothineni, Luigi DiBiase, Mohit Turagam, Rakesh Gopinathannair, Rodney Horton, Saibal Kar, Gregory Fontana, Shephal K. Doshi, Vijay Swarup, Aloke Finn, Vivek Reddy, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Incomplete left atrial appendage (LAA) closure is an evolving topic of clinical significance and thromboembolic potential, with recent long-term studies suggesting lower cutoffs for relevant leak size. Objectives: The aim of this prospective observational study was to assess 3 different closure techniques for persistent peridevice leaks after incomplete LAA closure and compare their efficacy and safety outcomes. Methods: We studied 160 patients (mean age 72 ± 9 years; 71% men) who underwent 1 of the 3 available modalities (detachable embolization coils, vascular plugs or septal occluders, and radiofrequency ablation) for residual central or eccentric leak closure. Both acute postprocedural success (closure or <1-mm leak at the end of the procedure) and closure at 1-year follow-up transesophageal echocardiography imaging were evaluated. Results: Of 160 patients, 0.6%, 41.3%, and 58.1% had mild (1-2 mm), moderate (3-5 mm), and severe (≥5 mm) leaks, respectively. Baseline LAA closure type was 72.5% Watchman FLX, 16.3% Lariat, 5.6% surgical ligation, 1.9% AtriClip, and 1.9% Amulet. Successful closure (0- or <1-mm leak) was seen in 100% of patients in all cohorts following intervention, with overall complete closure (0-1 mm) or mild or minimal leaks (1-2 mm) on 1-year follow-up transesophageal echocardiography seen in 100% of the atrial septal occluder or vascular plug cohort, 85.9% of the coil cohort, and 83.3% of the radiofrequency ablation cohort (P < 0.001). Two patients (1.3%) experienced cardiac tamponade, and there were no deaths or other complications. Conclusions: Peridevice leaks can safely and effectively be closed using 3 different modalities depending on size and location.

Original languageEnglish (US)
Pages (from-to)2158-2170
Number of pages13
JournalJACC: Cardiovascular Interventions
Volume15
Issue number21
DOIs
StatePublished - Nov 14 2022

Keywords

  • atrial fibrillation
  • central leaks
  • leak closure
  • left atrial appendage
  • left atrial appendage closure
  • peridevice leaks

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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