Introduction
Stroke prevention belongs to the key management among patients with atrial fibrillation (AF). Left atrial appendage (LAA) is the remnant of original left atrium (LA) in the period of embryo, and is a known major location of thrombosis in AF patients[1]. Percutaneous endovascular left atrial appendage closure (LAAC) is increasingly performed in AF patients, especially those with contraindications to long-term oral anticoagulants (OAC). This clinical practice conforms to the European Society of Cardiology guidelines with class IIB recommendation for LAAC in AF patients with high-stroke risk and contraindications to long-term OAC[2].
However, previous studies have revealed that postoperative peri-device leak (PDL) might occur in more than 40% of cases post LAAC[3]. Presence of PDL indicates the continued participation of LAA in the system circulation, which might still be linked with the potential risk of future stroke despite LAAC.
Recently, some researchers evidenced the presence of contrast enhancement, a sign of incomplete endothelialization of the device, post LAAC by cardiac computed tomography (CT)[4]. The determinants of PDL and device incomplete endothelialization post LAAC as well as the relationship between PDL and device incomplete endothelialization remain elusive now. In this study, we sought to evaluate the prevalence of PDL and the incomplete endothelialization post Watchman LAAC by the mean of cardiac computed tomography angiography (CCTA), and explore the predictors of postoperative PDL and incomplete endothelialization.