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.