Arrhythmias & electrophysiologyMeta-analysis
Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis
- Systematic review and meta-analysis
- random-effects
- Literature search until 19 February 2023
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)
Pooled result
As reported in the abstract
TEE-based PDL vs no reported PDL
Pooled odds ratio (pOR)
- thromboembolism
- 2.04 (95% CI 1.52–2.74)
- all-cause mortality
- 1.16 (95% CI 1.08–1.24)
- major bleeding
- 1.12 (95% CI 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) |
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:10.1093/eurheartj/ehad828
Summarised from the published abstract; every number is checked against it