Arrhythmias & electrophysiology
Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis
Authors' conclusion
Peri-device leak detected by TEE was associated with adverse events, primarily thromboembolism. Residual leaks detected by CT were more frequent but lacked prognostic significance.
Study context
- Population
- Patients with AF who underwent percutaneous LAAO48 studies (4 randomized)
- Participants
- 61,666 patients
- Comparison
- Residual leak vs no residual leak after LAAO
- Outcome
- Clinical impact of residual leaks (thromboembolism, all-cause mortality, major bleeding)
Methodological detailsrandom-effects, Literature search until 19 February 2023
- Random-effects
- Literature search until 19 February 2023
Pooled result
As reported in the abstract
TEE-based PDL vs no reported PDL
PDL vs No PDLPooled odds ratio (95% CI)
Thromboembolism
2.04(1.52–2.74)
All-cause mortality
1.16(1.08–1.24)
Major bleeding
1.12(1.03–1.22)
Further pooled results
| Outcome | pOR (95% CI) | |
|---|---|---|
| Thromboembolism by TEE PDL size cut-off — PDL >0 mm vs No PDL or PDL smaller than cut-off | 1.82 (1.35–2.47) | |
| Thromboembolism by TEE PDL size cut-off — PDL >1 mm vs No PDL or PDL smaller than cut-off | 2.13 (1.04–4.35) | |
| Thromboembolism by TEE PDL size cut-off — PDL >3 mm vs No PDL or PDL smaller than cut-off | 4.14 (2.07–8.27) | |
| Thromboembolism by TEE PDL size cut-off — PDL >5 mm vs No PDL or PDL smaller than cut-off | 4.44 (2.09–9.43) | |
| Thromboembolism with residual leaks by CT — left atrial appendage patency vs No PDL · not associated with thromboembolism | 1.45 (0.84–2.50) | |
| Thromboembolism with residual leaks by CT — PDL by CT vs No PDL · not associated with thromboembolism | 1.04 (0.52–2.07) | |
| 0.10.31310Pooled odds ratio (log scale) |
Prevalence of residual leaks
- Peri-device leak by transoesophageal echocardiography (TEE)
- 26.1%
- Computed tomography (CT)-based left atrial appendage patency
- 54.9%
- CT-based PDL
- 57.3%
Thromboembolism by TEE PDL size cut-off
- Positive graded association between PDL size and thromboembolism risk across TEE cut-offs
Original publication
Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis. Eur Heart J. Published 13 December 2023. doi:10.
Summarised from the published abstract; every number is checked against it