Impact of Device Compression on Peridevice Leak After Left Atrial Appendage Closure: The Impression LAAC Study.

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-09-23 DOI:10.1016/j.jacep.2025.08.014

Vincenzo Mirco La Fazia, Roberto Galea, Domenico Giovanni Della Rocca, Carola Gianni, Antanas Gasys, Sanghamitra Mohanty, Raouf Madhkour, Nicola Pierucci, Prem Geeta Torlapati, Konstantina Chalkou, Gaetano Chiricolo, Caroline Chong-Nguyen, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Lorenz Räber, Andrea Natale

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引用次数: 0

Abstract

Background: Left atrial appendage closure (LAAC) is an established therapeutic strategy to prevent ischemic stroke in selected patients with atrial fibrillation. However, residual peridevice leaks (PDLs) post-LAAC remain a critical concern.

Objectives: This study sought to assess the clinical impact of Watchman FLX device overcompression.

Methods: Data on consecutive patients undergoing a transesophageal echocardiography (TEE)-guided LAAC between 2020 and 2023 in 2 high-LAAC volume centers were collected and patients with a device compression higher (overcompression group) or lower (normal compression group) than 30% as evaluated by procedural TEE were compared in terms of procedural complications, composite of cardiovascular death, ischemic stroke, or systemic embolism, and PDL at TEE follow-up.

Results: This study included 61 overcompression and 175 normal compression patients. Baseline and procedural characteristics did not differ between the 2 groups. Both composite of procedural complications (1.6% vs 1.7%; P = 0.968) and of cardiovascular death, ischemic stroke, or systemic embolism during follow-up (9.8% vs 12%; P = 0.971) did not significantly differ between the 2 groups. At 2-month TEE follow-up, the rate of residual PDL was significantly lower in the overcompression group (8.2% vs 32.6%; P < 0.001). At the multivariate analysis, the device compression rate was the only variable independently associated to risk of PDL at TEE follow-up (adjusted OR: 0.935; 95% CI: 0.927-0.948; P = 0.003).

Conclusions: In this dual-center cohort of TEE-guided LAAC, the overcompression group was independently associated to a higher rate of LAA occlusion at TEE follow-up.

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左心耳闭合后器械压迫对器械周围泄漏的影响：印象LAAC研究。

背景：左心房附件关闭术（LAAC）是一种针对房颤患者预防缺血性卒中的治疗策略。然而，laac后残留的外围设备泄漏（pdl）仍然是一个关键问题。目的：本研究旨在评估Watchman FLX装置过度压迫的临床影响。方法：收集2020年至2023年在2个高LAAC容量中心连续接受经食管超声心动图（TEE）引导的LAAC患者的数据，并比较手术TEE评估的器械压缩高于（过度压缩组）或低于（正常压缩组）30%的患者的手术并发症、心血管死亡、缺血性卒中或全体性栓塞的综合情况以及TEE随访时的PDL。结果：本研究包括61例过度压迫患者和175例正常压迫患者。两组患者的基线和手术特征无差异。术后并发症（1.6% vs 1.7%, P = 0.968）和随访期间心血管死亡、缺血性卒中或全身性栓塞（9.8% vs 12%, P = 0.971）两组间无显著差异。在2个月的TEE随访中，过度压迫组的残余PDL率显著降低（8.2% vs 32.6%; P < 0.001）。在多因素分析中，器械压缩率是TEE随访时PDL风险唯一独立相关的变量（校正OR: 0.935; 95% CI: 0.927-0.948; P = 0.003）。结论：在TEE引导LAAC的双中心队列中，TEE随访时，过度压迫组与LAA闭塞率较高独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.