Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them

Abstract

Purpose of Review Device-related thrombus (DRT) formation and incomplete left atrial appendage closure (LAAC) are the two major complications that can occur after LAAC and can potentially limit the success of such a procedure. This review discusses the incidence, clinical and/or prognostic significance, detection methods, treatment options, and potential strategies to prevent these complications. Recent Findings It has recently been proven that the presence of a DRT represents an independent predictor for ischemic stroke after LAAC. Continued need for anticoagulation due to incomplete LAAC is clinically relevant to the patient. Summary The appearances of a DRT or an incompletely closed LAA after a LAAC procedure are not rare complications. Due to the clinical and/or prognostic significance of these complications, it is important to detect them in a timely manner during followup by using the appropriate diagnostic imaging techniques. Since a DRT is associated with an increased risk of stroke, the therapy should be aggressive. In the case of incomplete LAA closure, an additional closure device may be used to complete occlusion and avoid lifelong anticoagulation therapy.

The progress of percutaneous left atrial appendage occlusion: A bibliometric analysis from 1994 to 2022

“…[ 29 ] Incomplete blockade (shunt >5 mm) can still lead to cardiogenic thrombosis, and oral anticoagulation will still be a daily task for these patients. [ 30 ] To address these issues, some scholars have proposed Three/3 Dimensions modeling of the LAA opening and then Three/3 Dimensions printing to guide LAAO, [ 31 ] while some scholars [ 32 ] have proposed multi-angle and multi-dimensional occlusion guidance to achieve the best fit of the occluder disk to the LAA opening. However, we believe that, in addition to the above methods, upgrading the blocking device, customizing the blocker according to the anatomical structure of the patient’s LAA and the opening, or adopting an umbrella-type structure for the external disk to cover as wide a range of LAA openings as possible may be a direction or trend for future research.…”

Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study

“…[28] There is also a risk of thrombus formation until the device is fully endothelialised [29]. Previous studies have considered a PDL measurement of less than 3mm as the threshold for insigni cance [30,31].…”

Echocardiography in Percutaneous Left Atrial Appendage Occlusion and Related Complications

“…However, it does not necessarily indicate a need for systemic anticoagulation. On the other hand, if a thrombus is attached to the occlusion device or found within the left atrium, anticoagulation is warranted 50 (Figure 7).…”