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Athanasios Samaras, Apostolos Tzikas, Left atrial appendage occlusion leaks matter: the cryptic interplay of post-procedural haemodynamic changes and device surveillance, European Heart Journal, Volume 45, Issue 41, 1 November 2024, Pages 4445–4446, https://doi.org/10.1093/eurheartj/ehae459
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This commentary refers to ‘Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis’, by A. Samaras et al., https://doi.org/10.1093/eurheartj/ehad828 and the discussion piece ‘Haemodynamic changes after interventional closure of the left atrial appendage may facilitate peri-device leaks’, by C. Stöllberger et al., https://doi.org/10.1093/eurheartj/ehae458.
Stöllberger et al. highlighted a potential correlation between heart failure (HF) and left atrial appendage occlusion (LAAO) due to the interaction of the procedure with left atrial compliance and reservoir function. Out of the 48 studies that were included in our meta-analysis,1 only 16 reported data regarding presence of HF at baseline, possibly due to the fact that HF was integrated in the CHA2DS2-VASc score. The mean frequency of HF was 28%. We performed additional meta-regression analyses which indicated that pre-existing HF does not exhibit a significant correlation with the occurrence of peri-device leaks (PDLs) (I2 value: 1.78%, R2 value: 0%, P = .914). Only two studies (Fry et al. and Sahiner et al.) reported a total of two deaths that were attributed to acute decompensated HF (unknown presence of PDL), while only one study (Cochet et al.) reported a case of newly developed HF (unknown presence of PDL).