Journal Article

5 Impact of preprocedural computer tomography versus transoesophageal echocardiography for left atrial appendage occlusion procedure planning

Kiernan, T, Millar, K, Waters, M, Soh, BWT, Killip, M, Gracias, C S, J O’Brien, Arnous, S, Sim, W H

2023

Overview

BackgroundThe left atrial appendage (LAA) is the central anatomical structure implicated in the pathogenesis of nonvalvular atrial fibrillation related strokes. Where long-term oral anticoagulation is contraindicated, percutaneous transcatheter left atrial appendage occlusion (LAAO) may be considered. Due to wide variation in LAA anatomy, preprocedural imaging is a key step for procedure planning. While transoesophageal echocardiography (TOE) remains the gold standard for procedure planning, high quality 3-dimensional images from cardiac computer tomography (CT) may provide more accurate sizing parameters, resulting in improvements to device selection and procedural efficiency. We compare the outcomes of preprocedural CT versus TOE for LAAO procedure planning.MethodsA single-centre retrospective cohort study of all LAAO procedures was performed. Patients received either preprocedural CT or TOE and were divided into CT or TOE group respectively. The primary outcome was procedure success and major adverse event rate. The secondary outcome was total procedure time, rate of device size change, and LAA sizing parameters.Results64 patients underwent LAAO in our centre. 39 (60.9%) and 25 (39.1%) had preprocedural CT and TOE respectively. There was no statistically significant difference in procedure success rate (100% vs 96.0%, P = 0.39) and major adverse event rate (5.1% vs 4.0%, P = 1.00) when CT was compared to TOE (table 1). Preprocedural CT was associated with significantly shorter total procedure time (mean, 104.6 minutes vs 139.6 minutes, P = 0.009) and lower rate of device size change (7.7% vs 28.0%, P = 0.039) when compared to TOE (table 2). The percentage device oversizing from measured landing zone was significantly lower in the CT group when compared to TOE (mean, 12.6% vs 18.6%, P = 0.02), suggesting CT parameters correlated more closely to anatomical dimensions. Preprocedural TOE was associated with significantly lower measured maximum landing zone diameter (mean, 20.8 mm vs 25.8 mm, P < 0.001) and higher rate of device upsizing (24.0% vs 2.6%, P = 0.01) when compared to CT.Abstract 5 Table 1Baseline patient characteristicsAbstract 5 Table 2Procedure outcomes, characteristics and left atrial appendage characteristicsConclusionLAAO preprocedural CT is associated with shorter total procedure time, lower rate of device size change, and is less likely to underestimate LAA sizing parameters when compared to preprocedural TOE.

• Publisher: BMJ Publishing Group LTD
• Subject: Tomography