Thread by @adnanalkhouli

All you need to know about residual peri-device leaks (PDLs) after LAA occlusion in this 🧵

💢How frequent?
💢Do they matter?
💢What’s their mechanism?
💢Best way to manage?

#CardioTwitter #MedEd #EPeeps

How frequent? It depends on how you define PDL!

📌 In PROTECT AF, any PDL at 45d was 41% but ⬇️ to 32% at 1yr (2/3 of leaks ≥3mm)

📌 In Amulet IDE, any PDL at 45d was 51% w Watchman & 36% w Amulet

📌 In PINNACLE FLX, any PDL w Watchman FLX was 17% at 45d & ⬇️ to 10.5% at 1yr

Do PDLs matter?

📌 Till recently, we thought they don’t based on early data from PROTECT AF, Amulet registry, etc.

📌 However, data presented at AHA showed that PDLs at 1yr were associated w worse 5yr outcomes

📌@cellisvandyep also recently showed worse outcomes w PDLs

So, do PDL after LAAO really matter?

Stay tuned! & join us for a LBCT/featured research session at ACC on April 3rd.

We will present the largest study on PDL from the NCDR LAAO registry👇

🔑 question:
What’s the mechanism of PDL?

📌Currently we arbitrarily group all leaks together as one entity

📌However, there are several mechanisms as shown👇

📌Clinical implications & management of PDL are likely related to their mechanism (small edge leak vs uncovered lobe)

How to best manage PDLs?

Reported solutions:

📌 Stay on OAC
📌 Plugs
📌 Double occluders
📌 Coils

But, only short-term data available.

My take; an ounce of prevention is worth a pound of cure.

Efforts should l focus on mitigation; new devices & steerable sheath might help

Final thoughts 💭

💢Leaks after LAAO are common

💢Data on clinical significance are conflicting (but more coming)

💢Definitions controversial (size vs mechanism, what size?)

💢Management challenging:
- OAC =🩸
- Plugs/coils = no long-term data

💢Mitigation strategies needed