Clinical utility of one-year transesophageal echocardiography after left atrial appendage closure: a tertiary care center experience
A Rioux, J B Veillette, G O'Hara, J Champagne, H Delarochelliere, E Salaun, J Beaudoin, B Labbe, D Belzile, P Y Turgeon, K O'Connor, M Bernier, J Rodes-Cabau, J M ParadisAbstract
Background
Transcatheter left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation in patients with contraindications. However, optimal long-term imaging follow-up strategy after the procedure remains uncertain.
Purpose
This study sought to assess the clinical relevance of systematic long-term follow-up imaging using transesophageal echocardiography (TEE) at 1 year after LAAC.
Methods
This was a single-center, retrospective cohort study including consecutive patients who underwent LAAC and had systematic TEE follow-up at 45 days and 1 year post-procedure. Clinical and echocardiographic outcomes were assessed at early (45-day) and late (1-year) follow-up. Baseline characteristics and outcomes were compared between patients with early or late device-related thrombosis (DRT) and those without DRT.
Results
Between 2013 and 2023, 191 patients underwent LAAC with systematic long-term TEE follow-up at our institution. Early DRT was detected in 10 patients (5.2%) at a mean of 51.4 ± 14.3 days after LAAC, whereas late DRT was identified in 6 patients (3.1%) at a mean of 403.4 ± 62.4 days after LAAC. Among patients with late DRT, 2 had a prior early DRT that had resolved on interim imaging before recurrence at 1 year. Patients with early or late DRT tended to be older than those without DRT (79 ± 5.7 and 81 ± 4.0 vs. 74 ± 7.6 years, respectively; p = 0.09 and p = 0.06), while other baseline and procedural characteristics were similar across groups. At early TEE, 20 patients (10.8%) had a residual leak. Among them, 8 persisted at late TEE and 3 increased in size. Late TEE also identified 6 new residual leaks not present at early follow-up, all measuring > 5mm.
Conclusion
Systematic TEE imaging at 1 year after LAAC identifies a non-negligible proportion of late residual leaks and late device-related thrombosis, including recurrent DRT after apparent early resolution. These findings support the clinical relevance of long-term echocardiographic surveillance following LAAC.Figure 1.Timeline of patients with DRTFollow-up transesophageal echocardiographies