Long-term transesophageal echocardiography follow-up after percutaneous left atrial appendage closure

Stephan Staubach, Leonhard Schlatterbeck, Moritz Mörtl, Henning Strohm, Petra Hoppmann, Karl Ludwig Laugwitz, Harald Mudra, Jakob Ledwoch

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Peri-device leaks and device thrombi are assumed to lead to ischemic events after percutaneous left atrial appendage occlusion (LAAO). While these device-related complications are well assessed until 12 months after LAAO, no data are available beyond this period. Objective: The purpose of this study was to assess device-related complications beyond 12 months after LAAO. Methods: All patients who underwent successful percutaneous LAAO ≥12 months ago in the 2 participating centers were screened for eligibility. After inclusion, structured transesophageal echocardiography (TEE) was performed to assess peri-device leaks, device thrombus, and other device-related complications. Results: A total of 63 patients were enrolled in the present prospective, 2-center, nonrandomized, single-arm trial. The median time from implantation until long-term TEE was 3.1 years (interquartile range 2.0–5.1 years), ranging from 1.0 to 7.5 years. The number of patients without a detectable leak increased significantly at long-term TEE compared with 6-week follow-up (P = .04). Major peri-device leaks (>5 mm) were detected in 2 patients (3%). Device thrombus was found in 8 patients (13%). Patients with device thrombus at long-term follow-up had larger peri-device leaks at 6-week follow-up than did those without thrombus formation (3.0 [interquartile range 2.7–3.5] vs 1.4 [interquartile range 0.0–2.6]; P = .04). Of those who suffered an ischemic stroke during long-term follow-up (n = 5), 1 patient showed a peri-device leak >5 mm. None of the patients with detected device thrombus had a stroke. Conclusion: Peri-device leaks and device thrombi continue to occur during long-term follow-up after LAAO. The clinical impact of these late occluder complications requires further evaluation in larger prospective trials.

Original languageEnglish
Pages (from-to)728-733
Number of pages6
JournalHeart Rhythm
Volume17
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Device thrombus
  • Left atrial appendage closure
  • Long-term follow-up
  • Peri-device leak
  • TEE

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