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Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review
Background Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation. Methods This system...
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| Published in: | Journal of interventional cardiac electrophysiology 2024-06, Vol.67 (4), p.865-885 |
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| container_title | Journal of interventional cardiac electrophysiology |
| container_volume | 67 |
| creator | Helal, Baraa Khan, Jibran AlJayar, Dalia Khan, Mohammad Salman Alabdaljabar, Mohamad S. Asad, Zain Ul Abideen DeSimone, Christopher V. Deshmukh, Abhishek |
| description | Background
Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation.
Methods
This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management.
Results
A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3–5 mm: moderate, |
| doi_str_mv | 10.1007/s10840-023-01729-z |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2928996539</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3066609878</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-6a7b921fef5cf70d22f316327c92297a33aeea78b0fe1ea3a3b0b87109903c693</originalsourceid><addsrcrecordid>eNp9kUtvFiEUhidGYy_6B1wYEjcuHD2Aw8Vd02g1aWJidE0Y5vCFysAIM23arX9c6lcvceGKAzzvA8nbdU8ovKQA8lWloF5DD4z3QCXT_c297pAOkvVq0MP9v-aD7qjWCwDQwMTD7oArqpgW4rD7_inUr8Rbt-ZSXxAXQwrORhLmJbZhDTm1Y5smMttkdzhjWkn2ZMESJrwMDklE2ww5xnwV0q5t_UrsWkKz2GXBNLVYE-e6FXxDTki9rivOTe1IaQa8etQ98DZWfHy3Hndf3r39fPq-P_949uH05Lx3nIm1F1aOmlGPfnBewsSY51RwJp1mTEvLuUW0Uo3gkaLllo8wKklBa-BOaH7cPd97l5K_bVhXM4fqMEabMG_VMM2U1mLgt-izf9CLvJXUfmc4CCFAK6kaxfaUK7nWgt4sJcy2XBsK5rYis6_ItIrMz4rMTQs9vVNv44zT78ivThrA90BtV2mH5c_b_9H-AAGxnmI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3066609878</pqid></control><display><type>article</type><title>Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review</title><source>Springer Nature</source><creator>Helal, Baraa ; Khan, Jibran ; AlJayar, Dalia ; Khan, Mohammad Salman ; Alabdaljabar, Mohamad S. ; Asad, Zain Ul Abideen ; DeSimone, Christopher V. ; Deshmukh, Abhishek</creator><creatorcontrib>Helal, Baraa ; Khan, Jibran ; AlJayar, Dalia ; Khan, Mohammad Salman ; Alabdaljabar, Mohamad S. ; Asad, Zain Ul Abideen ; DeSimone, Christopher V. ; Deshmukh, Abhishek</creatorcontrib><description>Background
Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation.
Methods
This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management.
Results
A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3–5 mm: moderate, < 1 mm minor, or trivial. Follow up time for PDL detection was 7.15 ± 9.0 months. 33% had PDL, irrespective of PDL severity/size, and only 0.9% had PDL of greater than 5 mm. The main risk factors for PDL development included lower degree of over-sizing, lower left ventricular ejection fraction, device/LAA shape mismatch, previous radiofrequency ablation, and male sex. The most common methods to screen for PDL included transesophageal echocardiogram and cardiac CT. PDL Management approaches include Amplatzer Patent Foramen Ovale occluder, Hookless ACP, Amplatzer vascular plug II, embolic coils, and detachable vascular coils; removal or replacement of the device; and left atriotomy.
Conclusion
Following LAAC, the emergence of a PDL is a significant complication to be aware of. Current evidence suggests possible risk factors that are worth assessing in-depth. Additional research is required to assess suitable candidates, timing, and strategies to managing patients with PDL.</description><identifier>ISSN: 1572-8595</identifier><identifier>ISSN: 1383-875X</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-023-01729-z</identifier><identifier>PMID: 38182966</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation ; Appendages ; Atrial Appendage - diagnostic imaging ; Atrial Appendage - surgery ; Atrial Fibrillation - surgery ; Cardiology ; Case reports ; Criteria ; Echocardiography ; Female ; Heart ; Humans ; Left Atrial Appendage Closure ; Male ; Medicine ; Medicine & Public Health ; Patients ; Postoperative Complications - prevention & control ; Radio frequency ; Reviews ; Risk Factors ; Septal Occluder Device ; Stroke ; Stroke - etiology ; Stroke - prevention & control ; Systematic review ; Thromboembolism</subject><ispartof>Journal of interventional cardiac electrophysiology, 2024-06, Vol.67 (4), p.865-885</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-6a7b921fef5cf70d22f316327c92297a33aeea78b0fe1ea3a3b0b87109903c693</cites><orcidid>0000-0002-7632-666X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38182966$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Helal, Baraa</creatorcontrib><creatorcontrib>Khan, Jibran</creatorcontrib><creatorcontrib>AlJayar, Dalia</creatorcontrib><creatorcontrib>Khan, Mohammad Salman</creatorcontrib><creatorcontrib>Alabdaljabar, Mohamad S.</creatorcontrib><creatorcontrib>Asad, Zain Ul Abideen</creatorcontrib><creatorcontrib>DeSimone, Christopher V.</creatorcontrib><creatorcontrib>Deshmukh, Abhishek</creatorcontrib><title>Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><addtitle>J Interv Card Electrophysiol</addtitle><description>Background
Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation.
Methods
This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management.
Results
A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3–5 mm: moderate, < 1 mm minor, or trivial. Follow up time for PDL detection was 7.15 ± 9.0 months. 33% had PDL, irrespective of PDL severity/size, and only 0.9% had PDL of greater than 5 mm. The main risk factors for PDL development included lower degree of over-sizing, lower left ventricular ejection fraction, device/LAA shape mismatch, previous radiofrequency ablation, and male sex. The most common methods to screen for PDL included transesophageal echocardiogram and cardiac CT. PDL Management approaches include Amplatzer Patent Foramen Ovale occluder, Hookless ACP, Amplatzer vascular plug II, embolic coils, and detachable vascular coils; removal or replacement of the device; and left atriotomy.
Conclusion
Following LAAC, the emergence of a PDL is a significant complication to be aware of. Current evidence suggests possible risk factors that are worth assessing in-depth. Additional research is required to assess suitable candidates, timing, and strategies to managing patients with PDL.</description><subject>Ablation</subject><subject>Appendages</subject><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Appendage - surgery</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiology</subject><subject>Case reports</subject><subject>Criteria</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Left Atrial Appendage Closure</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Patients</subject><subject>Postoperative Complications - prevention & control</subject><subject>Radio frequency</subject><subject>Reviews</subject><subject>Risk Factors</subject><subject>Septal Occluder Device</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><issn>1572-8595</issn><issn>1383-875X</issn><issn>1572-8595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kUtvFiEUhidGYy_6B1wYEjcuHD2Aw8Vd02g1aWJidE0Y5vCFysAIM23arX9c6lcvceGKAzzvA8nbdU8ovKQA8lWloF5DD4z3QCXT_c297pAOkvVq0MP9v-aD7qjWCwDQwMTD7oArqpgW4rD7_inUr8Rbt-ZSXxAXQwrORhLmJbZhDTm1Y5smMttkdzhjWkn2ZMESJrwMDklE2ww5xnwV0q5t_UrsWkKz2GXBNLVYE-e6FXxDTki9rivOTe1IaQa8etQ98DZWfHy3Hndf3r39fPq-P_949uH05Lx3nIm1F1aOmlGPfnBewsSY51RwJp1mTEvLuUW0Uo3gkaLllo8wKklBa-BOaH7cPd97l5K_bVhXM4fqMEabMG_VMM2U1mLgt-izf9CLvJXUfmc4CCFAK6kaxfaUK7nWgt4sJcy2XBsK5rYis6_ItIrMz4rMTQs9vVNv44zT78ivThrA90BtV2mH5c_b_9H-AAGxnmI</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Helal, Baraa</creator><creator>Khan, Jibran</creator><creator>AlJayar, Dalia</creator><creator>Khan, Mohammad Salman</creator><creator>Alabdaljabar, Mohamad S.</creator><creator>Asad, Zain Ul Abideen</creator><creator>DeSimone, Christopher V.</creator><creator>Deshmukh, Abhishek</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7632-666X</orcidid></search><sort><creationdate>20240601</creationdate><title>Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review</title><author>Helal, Baraa ; Khan, Jibran ; AlJayar, Dalia ; Khan, Mohammad Salman ; Alabdaljabar, Mohamad S. ; Asad, Zain Ul Abideen ; DeSimone, Christopher V. ; Deshmukh, Abhishek</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-6a7b921fef5cf70d22f316327c92297a33aeea78b0fe1ea3a3b0b87109903c693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ablation</topic><topic>Appendages</topic><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial Appendage - surgery</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiology</topic><topic>Case reports</topic><topic>Criteria</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Left Atrial Appendage Closure</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Patients</topic><topic>Postoperative Complications - prevention & control</topic><topic>Radio frequency</topic><topic>Reviews</topic><topic>Risk Factors</topic><topic>Septal Occluder Device</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Systematic review</topic><topic>Thromboembolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Helal, Baraa</creatorcontrib><creatorcontrib>Khan, Jibran</creatorcontrib><creatorcontrib>AlJayar, Dalia</creatorcontrib><creatorcontrib>Khan, Mohammad Salman</creatorcontrib><creatorcontrib>Alabdaljabar, Mohamad S.</creatorcontrib><creatorcontrib>Asad, Zain Ul Abideen</creatorcontrib><creatorcontrib>DeSimone, Christopher V.</creatorcontrib><creatorcontrib>Deshmukh, Abhishek</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of interventional cardiac electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Helal, Baraa</au><au>Khan, Jibran</au><au>AlJayar, Dalia</au><au>Khan, Mohammad Salman</au><au>Alabdaljabar, Mohamad S.</au><au>Asad, Zain Ul Abideen</au><au>DeSimone, Christopher V.</au><au>Deshmukh, Abhishek</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review</atitle><jtitle>Journal of interventional cardiac electrophysiology</jtitle><stitle>J Interv Card Electrophysiol</stitle><addtitle>J Interv Card Electrophysiol</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>67</volume><issue>4</issue><spage>865</spage><epage>885</epage><pages>865-885</pages><issn>1572-8595</issn><issn>1383-875X</issn><eissn>1572-8595</eissn><abstract>Background
Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation.
Methods
This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management.
Results
A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3–5 mm: moderate, < 1 mm minor, or trivial. Follow up time for PDL detection was 7.15 ± 9.0 months. 33% had PDL, irrespective of PDL severity/size, and only 0.9% had PDL of greater than 5 mm. The main risk factors for PDL development included lower degree of over-sizing, lower left ventricular ejection fraction, device/LAA shape mismatch, previous radiofrequency ablation, and male sex. The most common methods to screen for PDL included transesophageal echocardiogram and cardiac CT. PDL Management approaches include Amplatzer Patent Foramen Ovale occluder, Hookless ACP, Amplatzer vascular plug II, embolic coils, and detachable vascular coils; removal or replacement of the device; and left atriotomy.
Conclusion
Following LAAC, the emergence of a PDL is a significant complication to be aware of. Current evidence suggests possible risk factors that are worth assessing in-depth. Additional research is required to assess suitable candidates, timing, and strategies to managing patients with PDL.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38182966</pmid><doi>10.1007/s10840-023-01729-z</doi><tpages>21</tpages><orcidid>https://orcid.org/0000-0002-7632-666X</orcidid></addata></record> |
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| subjects | Ablation Appendages Atrial Appendage - diagnostic imaging Atrial Appendage - surgery Atrial Fibrillation - surgery Cardiology Case reports Criteria Echocardiography Female Heart Humans Left Atrial Appendage Closure Male Medicine Medicine & Public Health Patients Postoperative Complications - prevention & control Radio frequency Reviews Risk Factors Septal Occluder Device Stroke Stroke - etiology Stroke - prevention & control Systematic review Thromboembolism |
| title | Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review |
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