Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT: A Meta-Analysis (JIMG December 2025)-Article: Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT: A Meta-Analysis

Article: Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT: A Meta-Analysis

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This meta-analysis by Jacquemyn et al. systematically evaluates the clinical significance of residual leaks—specifically left atrial appendage (LAA) patency and peridevice leaks (PDL)—detected by cardiac computed tomography (CT) following left atrial appendage occlusion (LAAO). LAAO is a nonpharmacologic alternative to oral anticoagulation for stroke prevention in atrial fibrillation patients, but residual leaks after implantation may pose thromboembolic risks.<br /><br />Seventeen studies encompassing 2,036 patients were analyzed using traditional and Bayesian meta-analytical methods. The pooled incidence of residual LAA patency and PDL detected by CT were high, at 54.6% and 51.5%, respectively, reflecting CT’s superior sensitivity compared to transesophageal echocardiography. Despite variability in imaging protocols and leak definitions, residual LAA patency was significantly associated with nearly a twofold increase in thromboembolism risk (OR 1.87; 95% CI: 1.08-3.24), translating to 28 additional thromboembolic events per 1,000 patients and a number needed to harm of 36. In contrast, PDL showed a similar but statistically nonsignificant trend toward increased risk (OR 1.50; 95% CI: 0.85-2.65). Bayesian analysis supported these findings, with a 98.5% posterior probability of increased thromboembolism risk associated with LAA patency.<br /><br />Further, LAA patency was linked to higher all-cause mortality but showed no significant effect on cardiovascular mortality. Subgroup analysis indicated that patients undergoing combined LAAO and ablation had a higher thromboembolic risk associated with residual leaks. Variability in device types and imaging definitions, as well as potential confounding by patient factors and anticoagulation therapy post-LAAO, represent study limitations.<br /><br />The study emphasizes that residual leaks detected by CT are clinically relevant and should not be considered benign. Current management recommendations suggest surveillance and individualized treatment strategies based on leak size and clinical context. The authors call for standardized definitions, improved surveillance protocols, and further research to clarify the relative risks posed by LAA patency versus PDL and optimize patient outcomes.

Keywords

left atrial appendage occlusion

residual leaks

left atrial appendage patency

peridevice leaks

cardiac computed tomography

atrial fibrillation

thromboembolism risk

meta-analysis

stroke prevention

anticoagulation alternatives