Comparing Measurements of Intracardiac Echocardiography and Other Periprocedural Imaging of the Left Atrial Appendage For Percutaneous Occlusion

Background: Intracardiac echocardiography (ICE) has recently been used as a safe and feasible imaging to guide left atrial appendage occlusion (LAAO). However, there is no good comparison of the correlation of left atrial appendage (LAA) measurements between ICE, transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy. Methods: We compared the correlation between ICE and CCTA, TEE, fluoroscopy on two key LAA measurements of each patient: (1) Lambre measured the landing zone and orifice; (2) Watchman measured the ostium and depth. Results: In this study, the success rate of operation was 100%, and no major adverse events occurred. For Lambre landing zone, mean measurements were 22.5±4.0mm with ICE, 23.5 ±4.5mm CCTA, 22.0±4.5mm TEE, 21.5±4.4mm fluoroscopy (P < 0.001). R values 0.78 ICE/CCTA, 0.85 ICE/TEE, 0.81 ICE / fluoroscopy; For Lambre orifice, mean measurements were 29.1±4.0mm with ICE, 31.0±3.9mm CCTA, 25.6±4.6mm TEE and 28.9±3.9mm fluoroscopy (P < 0.001). R values 0.68 ICE/CCTA, 0.76 ICE/TEE, and 0.75 ICE/fluoroscopy. For Watchman ostium, mean measurements were 22.7±3.2mm with ICE, 23.9±3.2mm CCTA, 21.9±3.1mm TEE, and 21.6±3.0mm fluoroscopy (P<0.001). R values 0.69 ICE/CCTA, 0.85 ICE/TEE, and 0.71 ICE/fluoroscopy; For Watchman depth, mean measurements were 22.1±3.1mm with ICE, 24.8±4.1mm CCTA, 23.7±2.9mm TEE, and 21.1±3.3mm fluoroscopy (P=0.002). R values 0.31 ICE/CCTA, 0.67 ICE/TEE, and 0.41 ICE/fluoroscopy. Conclusion: ICE from LA can be a safe and efficacious imaging option to guide LAAO, and ICE has good correlation with CCTA, TEE and fluoroscopy.

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

European Heart Journal ◽

10.1093/eurheartj/ehab724.0579 ◽

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<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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Cardiac computed tomography angiography is helpful to select patients for left atrial appendage occlusion with a watchman device

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(17)30213-6 ◽

2017 ◽

Vol 9 (1) ◽

pp. 68

Author(s):

G. Bonnet ◽

E. Salaun ◽

S. Deffarges ◽

T. Cuisset ◽

J. Bonnet

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Left Atrial ◽

Left Atrial Appendage ◽

Cardiac Computed Tomography ◽

Atrial Appendage ◽

Cardiac Computed Tomography Angiography ◽

Left Atrial Appendage Occlusion ◽

Watchman Device

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

10.21203/rs.3.rs-795122/v1 ◽

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.

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