Left atrial appendage occlusion: can CCT see the leaks?

Left atrial appendage occlusion (LAAO) has emerged as an effective stroke prevention strategy in non-valvular atrial fibrillation (AF), revolutionising the approach to high bleeding risk AF patients. Device-related thrombus (DRT) and significant peridevice leakage (PDL) remain major postprocedural concerns and have been studied in the short and intermediate term.

Historically, small PDLs were noted to be common in landmark trials, with the presence of any PDL ranging from 8.4% to 53.9% at 45 days12. Moderate and severe PDLs (≥3 mm diameter jet) were associated with worse outcomes and were more likely to persist compared to smaller PDLs34. Both size and incidence were found to have a temporal variation after LAAO3. In the PROTECT AF trial, the incidence of PDLs of any size decreased from 40.9% to 32.1% in 1 year, while the Amulet IDE trial noted that PDL ≥3 mm decreased from 25.9% to 21.7% in the WATCHMAN (Boston Scientific) arm and 11.2% to 9.5% in the Amulet (Abbott) arm over 1 year as well14. Most prior studies have focused on follow-up imaging at...