Prognostic Impact of Left Atrial Appendage Patency After Device Closure

作者：Mu Chen, Peng‐Cheng Yao, Zhen-Tao Fei, Qunshan Wang, Yi-Chi Yu, Peng‐Pai Zhang, Wei Li, R Zhang, Bin‐Feng Mo, Mingzhe Zhao, Yi Yu, Mei Yang, Yan Zhao, Chang‐Qi Gong, Jian Sun, Yi‐Gang Li · 发表于：Circulation Cardiovascular Interventions · 年份：2024 · DOI：10.1161/circinterventions.123.013579 · 被引用次数：12 · 研究领域：Atrial Fibrillation Management and Outcomes、Pericarditis and Cardiac Tamponade、Cardiac Arrhythmias and Treatments

BACKGROUND: The prognostic impact of left atrial appendage (LAA) patency, including those with and without visible peri-device leak (PDL), post–LAA closure in patients with atrial fibrillation, remains elusive. METHODS: Patients with atrial fibrillation implanted with the WATCHMAN 2.5 device were prospectively enrolled. The device surveillance by cardiac computed tomography angiography was performed at 3 months post-procedure. Adverse events, including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular death, all-cause death, and the combined major adverse events (MAEs), were compared between patients with complete closure and LAA patency. RESULTS: Among 519 patients with cardiac computed tomography angiography surveillance at 3 months post–LAA closure, 271 (52.2%) showed complete closure, and LAA patency was detected in 248 (47.8%) patients, including 196 (37.8%) with visible PDL and 52 (10.0%) without visible PDL. During a median of 1193 (787–1543) days follow-up, the presence of LAA patency was associated with increased risks of stroke/TIA (adjusted hazard ratio for baseline differences, 3.22 [95% CI, 1.17–8.83]; P =0.023) and MAEs (adjusted hazard ratio, 1.12 [95% CI, 1.06–1.17]; P =0.003). Specifically, LAA patency with visible PDL was associated with increased risks of stroke/TIA (hazard ratio, 3.66 [95% CI, 1.29–10.42]; P =0.015) and MAEs (hazard ratio, 3.71 [95% CI, 1.71–8.07]; P =0.001), although LAA patency without visible PDL showed higher risks...