Analysis of related factors of residual leakage after left atrial appendage occlusion with Watchman occluder

  AIM   To evaluate the efficacy of Watchman occluder after left atrial appendage occlusion, to analyze the value of cardiac CT angiography (CCTA) in the diagnosis of peri-device leak after left atrial appendage occlusion and to explore the influencing factors of PDL formation.

  METHODS   The clinical and imaging data of 158 atrial fibrillation patients who were successfully treated with LAAO and CCTA in Taizhou People's Hospital were retrospectively analyzed to evaluate the efficacy after occlusion. The RESULTS of CCTA of 158 patients were divided into two groups according to whether there was peri-device leakage and no peri-device leakage (cross-fabric leakage was classified as no peri-device group). The pathogenesis, influencing factors and prevention strategies of PDL were also discussed.

  RESULTS   There was no significant difference in gender, age, type of atrial fibrillation (paroxysmal or persistent), CHA₂DS₂ VASc score, has-bled score, left ventricular ejection fraction, hypertension and diabetes between the two groups. There was significant difference in the history of cerebral infarction between the two groups (P<0.05). There was no significant difference between the two groups in terms of occluder compression ratio, eccentricity index, pulmonary artery systolic pressure and LAA mouth circumference measured by CCTA . There was significant difference between the two groups in terms of deviation rate ≥ 1 case (P<0.05). Three months after laao, CCTA reexamination in 158 patients showed that the occluder completely blocked 48 cases (30%), residual shunt 110 cases (70%), including 66 (42%) cases of PDL and 44 (28%) cases of cross fabric leakage. There was no significant difference between the two groups in occluder compression ratio, eccentricity index, pulmonary artery systolic pressure, left atrial appendage (LAA) mouth circumference measured by CCTA, operation method and LAA shape, and the deviation rate between the two groups was statistically significant (P<0.05). Of the 52 patients who underwent CCTA and tee three months after operation, 41 (79%) had no PDL diagnosed by TEE and 11 (21%) had PDL; 37 patients (35%) without PDL and 15 patients (29%) with PDL were diagnosed by CCTA. The detection rate of PDL by CCTA and TEE was statistically significant (P<0.01).

  CONCLUSION   The incidence of PDL after LAAO is high. CCTA can clearly display the plugging results, especially distinguish PDL from cross-fabric leakage, and display the cause of PDL formation through three-dimensional reconstruction , which is an ideal follow-up examination method after plugging.