AI Article Synopsis
- - Left atrial appendage closure (LAAC) helps prevent strokes in patients with atrial fibrillation, but peri-device leak (PDL) might increase the risk of thromboembolic events.
- - A systematic review of 54,279 patients from 11 studies revealed that PDL significantly raised the odds of experiencing strokes, transient ischemic attacks (TIAs), or systemic embolisms.
- - Despite the increased risk of thromboembolic events linked to PDL, the study found no significant differences in overall mortality, cardiovascular mortality, or ischemic strokes.
Article Abstract
Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I statistics to assess statistical heterogeneity; I >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.
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| http://dx.doi.org/10.1016/j.amjcard.2023.07.102 | DOI Listing |
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