Clinical Implications and Management Strategies for Left Atrial Appendage Leaks

Anu Sahore¹, Domenico G Della Rocca², Alisara Anannab³, Sanghamitra Mohanty¹, Krishna Akella⁴, Ghulam Murtaza⁴, Chintan Trivedi¹, Carola Gianni¹, Qiong Chen¹, Mohamed Bassiouny¹, Ashkan Ahmadian-Tehrani⁵, Bryan Macdonald¹, Amin Al-Ahmad¹, Nicola Tarantino⁶, Donatello Cirone⁷, Rodney P Horton¹, Jorge Romero⁶, Dhanunjaya Lakkireddy⁴, Luigi Di Biase⁸, Andrea Natale⁹

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. Electronic address: domenicodellarocca@hotmail.it.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand.
⁴ Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA.
⁵ Department of Medicine, Division of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
⁶ Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁸ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
⁹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA.

PMID: 32067651
DOI: 10.1016/j.ccep.2019.11.010

Review

Clinical Implications and Management Strategies for Left Atrial Appendage Leaks

Anu Sahore et al. Card Electrophysiol Clin. 2020 Mar.

. 2020 Mar;12(1):89-96.

doi: 10.1016/j.ccep.2019.11.010.

Authors

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. Electronic address: domenicodellarocca@hotmail.it.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand.
⁴ Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA.
⁵ Department of Medicine, Division of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
⁶ Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁸ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
⁹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA.

PMID: 32067651
DOI: 10.1016/j.ccep.2019.11.010

Abstract

Left atrial appendage (LAA) is the dominant source of systemic thromboembolic (TE) events in patients with nonvalvular atrial fibrillation (AF). In patients with significant bleeding risk, various LAA exclusion strategies have been developed as an alternative to pharmacologic TE prophylaxis. Nevertheless, in a relatively small percentage of patients, incomplete LAA closure can be documented, either at the time of procedure or during follow-up. This persistent patency can potentially jeopardize an effective stroke prophylaxis. Hereby, we report an update on the current clinical implications of LAA leaks and how to manage them.

Keywords: Amulet; Lariat; Leak; Left atrial appendage; Outcome; Stroke; Transient ischemic attach; Watchman.

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Clinical Implications and Management Strategies for Left Atrial Appendage Leaks

Affiliations

Clinical Implications and Management Strategies for Left Atrial Appendage Leaks

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Abstract

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Medical