Infective endocarditis associated with left atrial appendage occlusion device: a contemporary systematic review

Alejandro Sanchez-Nadales; Muftawu Iddrisu; Roshan Wardak; Genesis M Arriola; Jose Baez-Escudero; Bo Xu

doi:10.1007/s10840-024-01838-3

Infective endocarditis associated with left atrial appendage occlusion device: a contemporary systematic review

J Interv Card Electrophysiol. 2024 Jul 3. doi: 10.1007/s10840-024-01838-3. Online ahead of print.

Authors

Alejandro Sanchez-Nadales¹, Muftawu Iddrisu², Roshan Wardak³, Genesis M Arriola¹, Jose Baez-Escudero⁴, Bo Xu⁵

Affiliations

¹ Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, Weston Campus, FL, 33324, USA.
² Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA.
³ Department of Internal Medicine, Cleveland Clinic Florida, 33321, Weston, FL, USA.
⁴ Department of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA.
⁵ Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. xub@ccf.org.

PMID: 38958851
DOI: 10.1007/s10840-024-01838-3

Abstract

Background: Data are limited regarding infective endocarditis (IE) complicating left atrial appendage occlusion (LAAO) device procedures. This systematic review examines the etiology, diagnosis, and management of infective endocarditis (IE) following LAAO.

Methods: A comprehensive search of six databases was performed between 2007 and 2022. In selecting studies, articles were included if they provided information about IE complicating LAAO, with relevant clinical and imaging details. Articles were excluded if they were editorials, study protocols, letters, or abstracts.

Results: We identified seven cases of IE complicating LAAO published between 2007 and 2022, from the United States and Europe, highlighting the exceedingly rare reported incidence of the condition. Staphylococcus aureus is the predominant organism implicated in LAAO infections. Echocardiography is a key imaging modality for diagnosing LAAO IE. Both antibiotic therapy and surgical intervention in appropriate patients are important for managing LAAO device-related IE.

Conclusions: The limited data in the current literature regarding LAAO IE underscores the need for prospective clinical trials to establish evidence-based guidelines for infection prophylaxis, diagnosis, and management. Our findings emphasize the importance of vigilance for device-related infections, especially as the use of LAAO devices continues to grow worldwide.

Keywords: 18F-FDG-PET imaging; Atrial fibrillation; Echocardiography; Infective endocarditis; Left atrial appendage occlusion device; Multimodality cardiovascular imaging.