Abstract 12203: Safety and Effectiveness of Pre-Procedure Imaging for Percutaneous Left Atrial Appendage Occlusion: Insights From the National Cardiovascular Data Registry (NCDR) LAAO Registry

Abstract

Introduction: Pre-procedure cardiac computed tomography (CT) or magnetic resonance imaging (MRI) prior to percutaneous left atrial appendage occlusion (LAAO) has many theoretical benefits but data on its association with periprocedural safety and effectiveness is limited. Hypothesis: Pre-procedure imaging has the potential to improve the safety and effectiveness of LAAO. Methods: We evaluated patients in the NCDR LAAO Registry who underwent LAAO between 1/2016 and 6/2021 to compare the safety and effectiveness of LAAO procedures by use vs. non-use of pre-procedural CT/MRI. Study outcomes included implant success (deployment and release of device), device success (device released with peri-device leak <5mm), and procedure success [device released with peri-device leak <5mm and no in-hospital MAE (major adverse effects)]. Multivariable logistic regression was used to assess the relationship between pre-procedure imaging and outcomes. Results: Pre-procedure CT/MRI was used for 18.2% (n=20,851) of the 114,384 procedures in this study and significant variability was noted by hospital ( Figure ). CT/MRI use was more common among government and university hospitals, larger hospitals, non-teaching hospitals, and hospitals in the Midwest and south, and was less common among patients with uncontrolled hypertension, abnormal renal function, and no prior thromboembolism. Overall rates of implant success, device success, and procedure success were 93.4%, 91.2%, and 89.4%. Pre-procedure CT/MRI was independently associated with an increased likelihood of implant success (OR 1.08, CI 1.00-1.17), device success (OR 1.10, CI 1.04-1.16), and procedural success (OR 1.07, CI 1.02-1.13) There was no significant difference in risk for MAE (OR 1.02, 0.92-1.12). Conclusions: Pre-procedure CT/MRI was used 1 in 5 LAAO procedures and was independently associated with higher likelihood of implant success, device success, and procedure success, but no difference in MAE.