Background. Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (cCTA) are used for evaluation of successful interventional left atrial appendage (LAA) closure (LAAC). A Peri-device leak (PDL) is a post-implantation complication, that can be assessed by both examinations. This longitudinal observational study directly compares TEE and cCTA at 6 months of follow-up after LAAC for the detection of PDL.

Methods. TEE and cCTA datasets were obtained six months after successful LAAC in consecutive treated patients. The initial decision of implantation of WATCHMAN^TM or AMPLATZER^TM AMULET^TM was based on individual patients’ characteristics such as LAA anatomy at the operator’s discretion.

Results. A total of 42 patients had successful LAAC (median age 78 years, 29% female, 64% WATCHMAN^TM device) and received TEE and cCTA follow-up. Overall accordance of TEE and CT was poor (60%). TEE did not report a single PDL in AMPLATZER^TM AMULET^TM devices, however cCTA showed 7 leaks with a median size of 2.7mm (IQR 2.3-3.0mm). No thromboembolic complications occurred at the follow-up period of 1 year thereafter.

Conclusion. PDL are common after successful LAAC therapy, while consequences are still poorly understood. TEE and cCTA showed an accordance of only 60% for detection of PDL 6 months after successful LAAC in this cohort. TEE might underestimate PDL in AMPLATZER^TM AMULET^TM devices.