Prevalence, mechanisms and impact of residual patency and device-related thrombosis following left atrial appendage occlusion: a computed tomography analysis.
Journal
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
ISSN: 1969-6213
Titre abrégé: EuroIntervention
Pays: France
ID NLM: 101251040
Informations de publication
Date de publication:
03 Dec 2021
03 Dec 2021
Historique:
pubmed:
6
7
2021
medline:
15
12
2021
entrez:
5
7
2021
Statut:
epublish
Résumé
Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However, the available experience is limited. The aim of this study was to determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification. Consecutively enrolled patients who underwent LAAO with an AMPLATZER device were followed up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed. A total of 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3, 95% CI: 13.6-107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism. Any degree of hypo-attenuated thickening (HAT) was found in 16.8% (n=23) of patients, of whom 16 (11.7%) had low-grade HAT and 7 (5.1%) had high-grade HAT or definite DRT. Complete sealing was associated with increased rates of low-grade HAT. LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability. Patency was not associated with adverse outcomes. Low-grade HAT may be related to a benign, uneventful, endothelialisation process favoured by complete LAAO.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However, the available experience is limited.
AIMS
OBJECTIVE
The aim of this study was to determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification.
METHODS
METHODS
Consecutively enrolled patients who underwent LAAO with an AMPLATZER device were followed up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed.
RESULTS
RESULTS
A total of 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3, 95% CI: 13.6-107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism. Any degree of hypo-attenuated thickening (HAT) was found in 16.8% (n=23) of patients, of whom 16 (11.7%) had low-grade HAT and 7 (5.1%) had high-grade HAT or definite DRT. Complete sealing was associated with increased rates of low-grade HAT.
CONCLUSIONS
CONCLUSIONS
LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability. Patency was not associated with adverse outcomes. Low-grade HAT may be related to a benign, uneventful, endothelialisation process favoured by complete LAAO.
Identifiants
pubmed: 34219668
pii: EIJ-D-21-00320
doi: 10.4244/EIJ-D-21-00320
pmc: PMC9724939
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e944-e952Références
J Am Coll Cardiol. 2012 Mar 6;59(10):923-9
pubmed: 22381428
JACC Cardiovasc Interv. 2013 Jun;6(6):606-13
pubmed: 23787233
JACC Cardiovasc Interv. 2017 Feb 27;10(4):391-399
pubmed: 28231907
Eur Heart J Cardiovasc Imaging. 2018 Dec 1;19(12):1351-1361
pubmed: 29415203
Circulation. 2013 Feb 12;127(6):720-9
pubmed: 23325525
J Am Coll Cardiol. 2012 Aug 7;60(6):531-8
pubmed: 22858289
Circulation. 2018 Aug 28;138(9):874-885
pubmed: 29752398
EuroIntervention. 2017 Sep 20;13(7):867-876
pubmed: 28649053
Int J Cardiol. 2013 Sep 30;168(2):1023-7
pubmed: 23273340
Rofo. 2016 Jan;188(1):45-52
pubmed: 26422416
Catheter Cardiovasc Interv. 2010 Aug 1;76(2):181-5
pubmed: 20665856
JACC Cardiovasc Interv. 2021 Jan 11;14(1):83-93
pubmed: 33413869
EuroIntervention. 2016 Feb;11(10):1170-9
pubmed: 25604089
EuroIntervention. 2019 Oct 20;15(8):663-670
pubmed: 31217149
Heart Rhythm. 2017 Sep;14(9):1302-1308
pubmed: 28577840
Eur Heart J Cardiovasc Imaging. 2015 Nov;16(11):1198-206
pubmed: 25851318
Int J Cardiovasc Imaging. 2019 Apr;35(4):725-731
pubmed: 30421354
Europace. 2017 Jan;19(1):4-15
pubmed: 27540038
Lancet. 2009 Aug 15;374(9689):534-42
pubmed: 19683639
Circ Cardiovasc Interv. 2019 Sep;12(9):e008112
pubmed: 31514523
Circulation. 2019 Oct 22;140(17):1441-1443
pubmed: 31634013
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
Catheter Cardiovasc Interv. 2015 Feb 1;85(2):306-12
pubmed: 25205611
J Am Coll Cardiol. 2014 Jul 8;64(1):1-12
pubmed: 24998121
J Cardiol. 2017 Dec;70(6):571-577
pubmed: 28546017
Int J Cardiol. 2020 Nov 15;319:78-84
pubmed: 32634500
JACC Cardiovasc Interv. 2019 Jun 10;12(11):1003-1014
pubmed: 31103540
Can J Cardiol. 2019 Apr;35(4):405-412
pubmed: 30935631
EuroIntervention. 2020 Jan 17;15(13):1133-1180
pubmed: 31474583