title: Cardiac CT and echocardiographic evaluation of peri-device flow after percutaneous left atrial appendage closure using the AMPLATZER cardiac plug device.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Costantina
authors.initials: C
authors.lastname: Manes
authors.forename: Gilbert
authors.initials: G
authors.lastname: Puippe
authors.forename: Sacha
authors.initials: S
authors.lastname: Salzberg
authors.forename: Maja
authors.initials: M
authors.lastname: Müller
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Thomas
authors.initials: T
authors.lastname: Lüscher
authors.forename: Andreas
authors.initials: A
authors.lastname: Luft
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: atrial fibrillation; cardiac-CT; first generation AMPLATZER Cardiac Plug; left atrial appendage closure; peri-device leaks; stroke