BACKGROUND Left atrial appendage closure (LAAC) is a safe and effective method for preventing embolic events in patients with nonvalvular atrial fibrillation (NVAF). However, peridevice leaks (PDLs) are sometimes unavoidable. Controversy exists regarding whether PDLs lead to embolic events. OBJECTIVES This study aimed to explore the association between PDLs and embolic events, including ischaemic stroke, transient ischaemic attacks (TIA), and systemic embolism (SE). METHODS We conducted a systematic search of the PubMed, Web of Science, MEDLINE, and Cochrane Library databases for studies published up to September 25, 2022, to compare the rate of ischaemic stroke/TIA/SE between the PDL group and the non-PDL group after LAAC. RESULTS Thirteen studies comprising 54,405 patients were included in the meta-analysis. The PDL group detected by transoesophageal echocardiography (TEE) had a significantly higher rate of ischaemic stroke/TIA/SE than the non-PDL group (OR: 1.20, 95% CI: 1.08-1.33, P=0.0009). However, no difference in ischaemic stroke/TIA/SE was found between the PDL and non-PDL subgroups of the cardiac computed tomography angiography (CCTA) group (OR: 1.12, 95% CI: 0.51-2.50, P=0.77). CCTA and TEE showed different rates of PDL detection, with the CCTA group having a higher rate of PDL detection (P<0.0001), especially for trivial leaks. CONCLUSIONS PDL detected by TEE increases the risk of embolic events after LAAC. However, no association was found between PDL and ischaemic stroke/TIA/SE in the CCTA group, which showed a higher rate of PDL detection than TEE, particularly for trivial leaks. In the future, CCTA may be used to explore the relationship between PDL size and ischaemic stroke/TIA/SE.

中文翻译：

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左心耳封堵后装置周围渗漏对缺血性卒中/TIA/SE 的影响：系统评价和荟萃分析。

背景左心耳封堵术（LAAC）是预防非瓣膜性心房颤动（NVAF）患者栓塞事件的安全有效的方法。然而，设备周围泄漏 (PDL) 有时是不可避免的。关于 PDL 是否会导致栓塞事件存在争议。目的 本研究旨在探讨 PDL 与栓塞事件之间的关联，包括缺血性中风、短暂性脑缺血发作 (TIA) 和全身性栓塞 (SE)。方法 我们对 PubMed、Web of Science、MEDLINE 和 Cochrane 图书馆数据库中截至 2022 年 9 月 25 日发表的研究进行了系统检索，以比较 PDL 组和非 PDL 组之间缺血性卒中/TIA/SE 的发生率LAAC 之后的组。结果 荟萃分析中纳入了 13 项研究，涉及 54,405 名患者。经食管超声心动图（TEE）检测到的PDL组缺血性脑卒中/TIA/SE发生率显着高于非PDL组（OR：1.20，95％CI：1.08-1.33，P=0.0009）。然而，心脏计算机断层扫描血管造影（CCTA）组的PDL和非PDL亚组之间的缺血性卒中/TIA/SE没有发现差异（OR：1.12，95％CI：0.51-2.50，P=0.77）。CCTA和TEE的PDL检出率不同，CCTA组的PDL检出率较高（P<0.0001），特别是对于轻微泄漏。结论 TEE 检测到的 PDL 增加了 LAAC 后发生栓塞事件的风险。然而，CCTA 组中未发现 PDL 与缺血性中风/TIA/SE 之间存在关联，这表明 PDL 检测率高于 TEE，特别是对于轻微渗漏。未来CCTA可能用于探讨PDL大小与缺血性卒中/TIA/SE之间的关系。