{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T07:22:46Z","timestamp":1793604166404,"version":"4.5.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The impact of peridevice leak (PDL) at device implantation on clinical outcomes after percutaneous left atrial appendage closure (LAAC) is unknown. This study aimed to investigate the association between PDL and clinical outcomes after LAAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Using data from the OCEAN\u2010LAAC (Optimized Catheter Valvular Intervention\u2010Left Atrial Appendage Closure) Japanese multicenter registry, we examined 1397 patients who underwent LAAC between September 2019 and December 2022. The primary outcome was transient ischemic attack, ischemic stroke, or systemic embolism within 2\u2009years of LAAC. Clinical outcomes were compared between patients with and without PDL at device implantation using Fine and Gray multivariable regression analyses and propensity score matching. Additional analyses were performed by categorizing PDL into 2 groups: \u22643\u2009mm and &gt;3\u2009mm but \u22645\u2009mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Of 1397 patients who underwent LAAC, 84 (6.0%) had PDL, of whom 73 (86.9%) had \u22643\u2009mm PDL. Patients with PDL had a larger left atrium and higher CHADS2 scores than those without PDL. Multivariable analyses showed that PDL was significantly associated with a higher risk of transient ischemic attack, ischemic stroke, or systemic embolism (adjusted subdistribution hazard ratio [sHR], 4.25 [95% CI, 1.91\u20139.44];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Even PDL \u22643\u2009mm was independently associated with an increased risk compared with no PDL (adjusted sHR, 3.53 [95% CI, 1.37\u20139.04];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.016). Propensity score matching analyses revealed consistent findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">PDL was associated with a higher risk of transient ischemic attack, ischemic stroke, or systemic embolism, even PDL \u22643\u2009mm. Therefore, it may be necessary to aim for no PDL as much as possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044422","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T10:37:09Z","timestamp":1755513429000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of Peridevice Leak on Clinical Outcomes After Left Atrial Appendage Closure: The OCEAN\u2010LAAC Registry"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5356-9477","authenticated-orcid":false,"given":"Tetsuya","family":"Saito","sequence":"first","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]},{"name":"Edogawa Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8645-0281","authenticated-orcid":false,"given":"Hikaru","family":"Tsuruta","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiyoshi","family":"Kajino","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6809-5259","authenticated-orcid":false,"given":"Juri","family":"Iwata","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0362-8584","authenticated-orcid":false,"given":"Shingo","family":"Sakata","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6450-860X","authenticated-orcid":false,"given":"Toshinobu","family":"Ryuzaki","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Sago","sequence":"additional","affiliation":[{"name":"Toyohashi Heart Center","place":["Toyohashi, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7551-3431","authenticated-orcid":false,"given":"Shuhei","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Toyama University Hospital","place":["Toyama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7622-8494","authenticated-orcid":false,"given":"Ryuki","family":"Chatani","sequence":"additional","affiliation":[{"name":"Kurashiki Central Hospital","place":["Kurashiki, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4828-1836","authenticated-orcid":false,"given":"Daisuke","family":"Hachinohe","sequence":"additional","affiliation":[{"name":"Sapporo Higashi Tokushukai Hospital","place":["Sapporo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Naganuma","sequence":"additional","affiliation":[{"name":"New Tokyo Hospital","place":["Chiba, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4203-7613","authenticated-orcid":false,"given":"Yohei","family":"Ohno","sequence":"additional","affiliation":[{"name":"Tokai University School of Medicine","place":["Isehara, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Tani","sequence":"additional","affiliation":[{"name":"Sapporo East Tokushukai Hospital","place":["Sapporo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8122-3561","authenticated-orcid":false,"given":"Hideharu","family":"Okamatsu","sequence":"additional","affiliation":[{"name":"Saiseikai Kumamoto Hospital Cardiovascular Center","place":["Kumamoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7206-4538","authenticated-orcid":false,"given":"Kazuki","family":"Mizutani","sequence":"additional","affiliation":[{"name":"Kinki University Faculty of Medicine","place":["Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2297-5303","authenticated-orcid":false,"given":"Yusuke","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Teikyo University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8597-1479","authenticated-orcid":false,"given":"Masaki","family":"Izumo","sequence":"additional","affiliation":[{"name":"St. Marianna University School of Medicine Hospital","place":["Kawasaki, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2057-109X","authenticated-orcid":false,"given":"Mike","family":"Saji","sequence":"additional","affiliation":[{"name":"Sakakibara Heart Institute","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Shonan 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