Predictive value of left atrial appendage morphology based on preoperative cardiac computed tomography angiography for peri-device leak after left atrial appendage closure in patients with atrial fibrillation

  AIM   To assess the incidence of peri-device leak (PDL) after left atrial appendage closure (LAAC) and the predictive value of left atrial appendage (LAA) morphology based on preoperative cardiac computed tomography angiography (CCTA) for PDL in patients with atrial fibrillation.

  METHODS  Seventy-two patients with atrial fibrillation who underwent LAAC successfully in our hospital from June 2021 to June 2022 were enrolled retrospectively and their clinical and image data were collected. Their preoprative CCTA images were analyzed for parameters of LA and LAA. The patients were classified into PDL group (n=29) and no-PDL group (n=43) based on reexamination 45 days after LAAC. Logistic regression analysis was performed to find the risk factors for PDL among the parameters with statistically significant differences between the two groups.

  RESULTS  The long diameter (35 ± 5) mm vs. (31 ± 7) mm, P<0.01, short diameter (26 ± 6) mm vs. (22 ± 4) mm, P<0.01, landing area (576 ± 166) mm² vs. (480 ± 161) mm², P<0.05 in PDL group were larger than these in non PDL group, and the pectinate muscles were statistical difference between the two groups (P<0.05). The volume of left atrium and left atrial appendage, the diameter of landing area, and the depth of left atrial appendage in PDL group were larger than those in non PDL group, but there was no statistical difference between the two groups. The indicators with statistical differences between groups were included in the single factor logistic regression analysis. The results showed that the LAA orifice long diameter (OR=1.118, 95% CI: 1.024~1.220, P<0.05), short diameter (OR=1.200, 95% CI: 1.073~1.343, P<0.01), landing area (OR=1.004, 95% CI: 1.000~1.007, P<0.05) and comb muscle development (OR=3.580, 95% CI: 1.314~9.756, P<0.05) were all related to postoperative PDL. After multivariate logistic regression correction, the short diameter of LAA orifice and the degree of comb muscle development were independent risk factors for PDL.

  CONCLUSION  The development of pectinate muscles and short diameter of LAA orifice on preoperative CCTA has potential predictive value for postoperative PDL in patients with atrial fibrillation. Well developed pectinate muscles and large short diameter of LAA orifice are risk factors for the occurrence of PDL following LAAC.