scholarly journals Pre-procedural Determination of Device Size in Left Atrial Appendage Occlusion Using Three-dimensional Cardiac Computed Tomography

2021 ◽  
Author(s):  
Iksung Cho ◽  
William D. Kim ◽  
Oh Hyun Lee ◽  
Min Jae Cha ◽  
Jiwon Seo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Three Dimensional ◽  
Atrial Appendage ◽  
Landing Zone ◽  
Left Atrial Appendage Occlusion ◽  
Device Size

Abstract Background: The two-dimensional-based LAAO size prediction system using transesophageal echocardiography is limited by the complex structure of the left atrial appendage (LAA). The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac CT; however, a CT-based sizing method has not been established. We aimed to assess the accuracy of measurements derived from cardiac computed tomography (CT) images for selecting left atrial appendage occlusion (LAAO) devices.Methods: We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes.Results: The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = -0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = -4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = -1.6 ± 2.6 mm, area-derived diameter = -2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference <0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement.Conclusions: The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.

scholarly journals Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Iksung Cho ◽  
William D. Kim ◽  
Oh Hyun Lee ◽  
Min Jae Cha ◽  
Jiwon Seo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Three Dimensional ◽  
Atrial Appendage ◽  
Landing Zone ◽  
Mean Error ◽  
Device Size

AbstractThe complex structure of the left atrial appendage (LAA) brings limitations to the two-dimensional-based LAA occlusion (LAAO) size prediction system using transesophageal echocardiography. The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac computed tomography (CT); however, there is lack of data regarding which parameter to choose from CT-based images during pre-procedural planning of LAAO. We aimed to assess the accuracy of measurements derived from cardiac CT images for selecting LAAO devices. We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes. The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = − 0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = − 4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = − 1.6 ± 2.6 mm, area-derived diameter = − 2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference < 0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement. The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.

Intraprocedural Hybrid Cardiac Computed Tomography for Left Atrial Appendage Occlusion

2021 ◽  
Vol 14 (16) ◽  
pp. 1852-1853
Author(s):  
Mahdi Veillet-Chowdhury ◽  
Stewart M. Benton ◽  
C. Anwar A. Chahal ◽  
James E. Harvey ◽  
Paul Tolerico ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion

P3730Left atrial appendage perimeter measurement by cardiac CT is superior to transesophageal echocardiography for Watchman device sizing

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Seibolt ◽  
D Verma ◽  
W Mulroy ◽  
A Loli
Keyword(s):  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Current Standard ◽  
Landing Zone ◽  
Pearson Coefficient ◽  
Watchman Device ◽  
Very High ◽  
Device Size

Abstract Background Left atrial appendage occlusion with Watchman device traditionally relies on accurate left atrial appendage (LAA) ostium diameter measurement by 2D or 3D transesophageal echocardiogram (TEE). Alternate methods of ostium measurement including area-derived diameter and perimeter-derived diameter using cardiac computed tomography (CT) have been proposed. Purpose We aim to use CT technology with an advanced medical imaging application to measure LAA ostium perimeter for improved pre-procedural device sizing. Methods We performed a retrospective analysis of 92 patients with atrial fibrillation (Afib) who underwent Watchman implantation with pre-procedural TEE and cardiac CT between May 2015 and December 2018. LAA characteristics including ostial or landing zone perimeter, minimum and maximum diameters were acquired utilizing 3mensio Structural Heart Imaging Program. Proposed Watchman device size was estimated utilizing ostium perimeter by CT and compared to the current standard utilizing ostium diameter by 2D-TEE. Both measurements were then compared to actual implanted Watchman device size which met the P.A.S.S. criteria of position, anchor, size and seal. Results Watchman device sizing based on novel LAA landing zone perimeter size by CT had a very high correlation with the actual implanted Watchman size (Pearson coefficient r=0.94, p<0.001). Traditional TEE based Watchman sizing only had a modest correlation with the implanted Watchman size (Pearson coefficient r=0.66, p<0.001). CT predicted Watchman size had a significantly higher agreement compared to current standard TEE based sizing (93.4% vs 47.8%), inter-rater agreement was very high for CT based Watchman sizing compared to current standard TEE based sizing (Cohen's kappa = 0.91 vs Cohen's kappa = 0.32, p<0.001, p<0.001 respectively). Bland-Altman analysis also showed better correlation with CT based sizing compared to TEE (see Figure 1). Figure 1 Conclusion CT LAA perimeter sizing is superior to the current standard TEE based Watchman sizing. Larger, multi-center studies may be necessary to further validate our results.

scholarly journals Predictors of Spontaneous Echocardiographic Contrast Within the Left Atrial Appendage in Cardiac Computed Tomography of Patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Kotaro Ouchi ◽  
Toru Sakuma ◽  
Takahiro Higuchi ◽  
Jun Yoshida ◽  
Ryosuke Narui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Atrial Appendage ◽  
Receiver Operator Characteristic

Abstract PurposeCardiac computed tomography (CT) depiction of the relationship between spontaneous echocardiographic contrast (SEC) and findings of the left atrial appendage (LAA) has not been reported. We evaluated predictors of SEC within the LAA using findings of cardiac CT in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed cardiac CT findings of the LAA, including morphology, volume, and filling defects, of 641 patients who underwent Transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) from January 6, 2013 through December 16, 2019 at our institution. We investigated potential associated factors that might be predictors of SEC and computed a receiver operator characteristic,choosing a threshold value at which the likelihood of SEC could be predicted based on the LAA volume indexed for body size.ResultsSEC correlated significantly with history of persistent AF (P<0.001; odds ratio [OR], 3.74; 95% confidence interval [CI], 1.91–7.29), LAA early filling defects (P =0.003; OR, 2.83; 95% CI, 1.43–5.62), LAAFV (P<0.001; OR, 0.97; 95% CI, 0.96–0.99), and indexed LAA volume (P = 0.001; OR, 1.18; 95% CI, 1.07–1.30) of 8.04 cm3/m2 or greater (sensitivity, 75.0%; specificity, 48.7%).The addition of LAAFV to indexed LAA volume increased the area under the receiver operator characteristic curve from 0.642 to 0.724 (P< 0.001).ConclusionFindings of LAA in cardiac CT might allow the noninvasive estimation of SEC and additional information for risk stratification and management of thromboembolic events in patients with AF.

scholarly journals One year outcome and analysis of peri-device leak of left atrial appendage occlusion devices

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Mansour ◽  
E Harnay ◽  
A Al Ayouby ◽  
V Mansourati ◽  
Y Jobic ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Male Gender ◽  
Atrial Appendage ◽  
P Value ◽  
Cardiac Computed Tomography Angiography ◽  
Landing Zone ◽  
Left Atrial Appendage Occlusion ◽  
Maximal Diameter

Abstract Background The prevalence of peri-device leak (PDL) of left atrial appendage occlusion (LAAO) devices has been previously reported. However, there have been only few data that compared different existing devices. The aim of this study was to assess the incidence of PDL with both devices WATCHMAN® and AMPLAZER Amulet®, and to evaluate the clinical outcome at 12 months. Methods Consecutive patients who underwent LAAO between January 2018 and 2020 were randomly assigned to either WATCHMAN or AMPLATZER Amulet implantation based on a systematic two-week alternation between both devices. LAA measurements were assessed using cardiac computed tomography angiography (CCTA) prior to, and transesophageal echocardiography (TEE) during the procedure. At 8 weeks post-LAAO, patients underwent TEE and/or CCTA to identify the presence of PDL and/or device-related complications. Patients were then followed for 12 months to identify major adverse cardiovascular/embolic events. Results The cohort consisted of 51 patients (25 WATCHMAN, 26 AMPLATZER Amulet; mean age 76±7 years; male gender 76%). Both groups were identically matched for demographics, comorbidities and indication for LAAO. There were 19 patients who had PDL (13 WATCHMAN vs 6 AMPLATZER Amulet, P-value=0.033). Of them, 8 (15%) patients had significant PDL (7 WATCHMAN vs. 1 AMPLATZER Amulet, P-value=0.018). On CCTA, the landing zone maximal diameter of the AMPLATZER Amulet device had the strongest correlation with the final deployed device size (Spearman'rho 0.92, P-value&lt;0.0001). In the multivariate analysis, male gender and device type were independent predictors of any PDL (P-values 0.016 and 0.031, respectively). On a mean follow-up of 12 months, the total number of events was more prevalent in the WATCHMAN group (P-value 0.008), but the incidence of cardio-embolic events reached borderline significance (16% vs. 0%, P-value=0.051). Conclusions Among patients who underwent LAAO, almost 15% had significant PDL with the majority belonging to the WATCHMAN group. Still, larger studies are warranted to evaluate its effectiveness in stroke prevention. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Table 2

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