Cardiac CT and echocardiographic evaluation of peri-device flow after percutaneous left atrial appendage closure using the AMPLATZER cardiac plug device

Catheter Cardiovasc Interv. 2015 Feb 1;85(2):306-12. doi: 10.1002/ccd.25667. Epub 2014 Oct 4.

Abstract

Objectives: The aim of the study was to examine frequency, size, and localization of peri-device leaks after percutaneous left atrial appendage (LAA)-closure with the AMPLATZER-Cardiac-Plug (ACP) by using a multimodal imaging approach, i.e. combined cardiac-CT and TEE follow-up.

Background: Catheter-based LAA-occlusion using ACP aims to reduce the risk of stroke in patients with atrial fibrillation. Detection of peri-device leaks after ACP implantation by TEE is challenging, the few available data are inconsistent and the frequency of LAA leaks after ACP implantation remains therefore unclear.

Methods: Cardiac-CT using a multi-phase protocol and a second-generation dual-source-CT-system was performed in 24 patients with non-valvular atrial fibrillation starting 3 months after LAA-closure by ACP. Color Doppler multiplane TEE was used to evaluate peri-device flow.

Results: Cardiac-CT follow-up detected any persistent LAA contrast filling in 62% of patients (n = 15), but leak-sizes were small (1.5 ± 1.4 mm). Peri-device leaks were almost exclusively localized at the posterior portion of the LAA-orifice (>90%). TEE follow-up revealed peri-device flow in 36% of patients (jet-sizes: ≤ 4 mm). ACP-lobe compression (>10%) and perpendicular ACP-lobe orientation to the LAA-neck axis, that was also dependent on LAA anatomy, were substantially more frequent in patients with complete LAA closure.

Conclusion: The present study evaluates for the first time peri-device flow after LAA closure by ACP using a combined cardiac-CT and TEE follow-up. Persistent LAA-perfusion was frequently detected, leak-sizes were small and were less frequent when lobe compression was >10% and lobe orientation was perpendicular to the LAA-neck axis, that was also related to the LAA anatomy. The clinical significance of these small leaks after LAA-closure using ACP needs to be further evaluated in future studies.

Keywords: atrial fibrillation; cardiac-CT; first generation AMPLATZER Cardiac Plug; left atrial appendage closure; peri-device leaks; stroke.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Atrial Appendage / diagnostic imaging*
  • Atrial Appendage / physiopathology
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation*
  • Echocardiography, Doppler, Color*
  • Echocardiography, Three-Dimensional*
  • Echocardiography, Transesophageal*
  • Equipment Design
  • Equipment Failure
  • Female
  • Hemodynamics
  • Humans
  • Male
  • Multimodal Imaging
  • Predictive Value of Tests
  • Tomography, X-Ray Computed*
  • Treatment Outcome