Abstract
Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural.
Highlights
Atrial Fibrillation (AF) is a major burden on public health, it is estimated to be the cause of ≥15% of all strokes in the United States, and >100,000–125,000 embolic strokes per year, of which >20% are fatal [1]
We present a review on the most commonly used imaging modality for pre-procedural planning and assessment of the left atrial appendage (LAA) morphology, which include 2D Transesophageal echocardiography (2D transesophageal echocardiography (TEE)), 3D Transesophageal echocardiography (3D TEE), Computed tomography (CT), and 3D Printing (3DP)
-The landing zone dimension of LAA revealed by 2D TEE, showed statistical difference compared with the dimensions obtained from the 3D TEE -No statistical difference was noticed in the landing zone values of 3D TEE compared with that of X-ray -No statistical difference was noticed in the landing zone values of 3D TEE compared with that of X-ray
Summary
Atrial Fibrillation (AF) is a major burden on public health, it is estimated to be the cause of ≥15% of all strokes in the United States, and >100,000–125,000 embolic strokes per year, of which >20% are fatal [1]. Zhou et al found 3D TEE to be more accurate than 2D TEE for measuring the LAA Landing zone, LAA depth, and LAA ostial dimensions, LAA morphology after the occlusion device deployment, and visualizing any residual shunts around the entire device in one more view. Nakajima et al determined that 3D TEE could accurately visualize LAA morphological variations They studied 55 patients in normal sinus rhythm and 52 patients with atrial fibrillation. -More accurate measuring of Landing zone and depth -More significant association between the closure device -Displaying cross-sectional images from any angle using Flexi Slice mode -Useful in displaying the LAA morphology after the occlusion device deployed -Visualizing any residual shunts around the entire device in one more view. -Accurately visualize LAA morphological variations -Excellent correlation was found between full volume mode and zoom mode
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