Peridevice leak (PDL) after left atrial appendage occlusion was more commonly found when measured with computed tomography (CT) than by transesophageal echocardiography (TEE). Even so, a study released Monday failed to show any difference in clinical outcomes.
Kasper Korsholm, MD, PhD, of Aarhus University Hospital, Denmark, and colleagues reported their findings in a manuscript published in the Jan. 11 issue of JACC: Cardiovascular Interventions.
The single-center study compared CT and TEE imaging of patients 8 weeks after left atrial appendage occlusion with either an Amplatzer Cardiac Plug or Amulet device implanted between 2010 and 2018. A novel classification system for PDL ranging from grade 1 to 3, based on PDL at the device disc, device lobe and LAA contrast patency, was used to quantify PDL on CT imaging. Ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death at 4 years were reported.
The study was notable in that it showed PDL was observed almost twice as frequently by CT when compared to TEE. PDL was present in 110 patients (32%) by TEE, with 29 (8%) >3 mm. By cardiac CT, 210 patients (61%) had PDL at the disc, with contrast patency in 204 patients (59%).
Furthermore, the study used Bland-Altman analysis to show poor agreement between measures of leak size by TEE and cardiac CT, with a larger leak size demonstrated by cardiac CT.
The authors wrote that the higher occurrence of PDL by cardiac CT may be explained by the higher spatial resolution of CT. The authors stipulate that because of the wide discrepancy between CT and TEE, a separate quantification system is warranted for CT-based assessment of PDL.
However, despite CT demonstrating PDL more often than TEE, the study found no difference in ischemic stroke, transient ischemic attacks, systemic embolism or all cause death.
In an accompanying editorial, Sameer Gafoor, MD, of Swedish Medical Center, Seattle, and CardioVascular Center Frankfurt, Germany, outlined some of the limitations of this single-center registry and asked if PDL is not clinically relevant, should practice shift toward minimizing device-related thrombosis, ensuring adequate antiplatelet and anticoagulation regimens and proper patient selection.
This study was funded by an unrestricted grant from the Novo Nordisk Foundation and Aarhus University. Dr. Korsholm has received speaker honoraria from Abbott and has received a travel grant from Boston Scientific.
Korsholm K, Jensen JM, Nørgaard BL, et al. Peridevice Leak Following Amplatzer Left Atrial Appendage Occlusion: Cardiac Computed Tomography Classification and Clinical Outcomes. JACC Cardiovasc Interv 2021;14:83–93.
Gafoor S. Does This Peridevice Leak Classification System Hold Water? JACC Cardiovasc Interv 2021;14:94–6.