Cardiac Computed Tomography versus 3D-Transesophageal Echocardiography in Preprocedural Planning of Left Atrial Appendage Closure

Jaroslaw Heinrich,Baravan Al-Kassou,Heyder Omran

doi:10.31579/2641-0419/145

Abstract

Aim: Preprocedural imaging of the left atrial appendage (LAA) plays a crucial role in the process of LAA closure (LAAC). This study aimed to compare the influence of preprocedural planning of the LAAC with 3D-transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) versus 3D-TEE alone in patients who underwent LAAC with an Amplatzer Cardiac Plug or Amulet. Materials and Methods: In a retrospective study, 176 patients received a preprocedural 3D-TEE and CCT and 167 patients a 3D-TEE only. Both groups had similar patient characteristics and indications for LAAC. Results: There was no difference in terms of procedural success, procedure time, amount of contrast medium, fluoroscopy time, or radiation dose. Patients with CCT/3D-TEE had a longer hospital stay on average. Besides, there was a different incidence of renal diseases (49% for 3D-TEE versus 27% for CCT/3D-TEE; p < 0.001). The number of periprocedural adverse events was comparable. A device-related thrombus occurred three times in each group, and the peri-device leaks reported were similar. Conclusion: A preprocedural CCT does not decrease major adverse events or improve outcome in patients undergoing LAAC.

Highlights

Atrial fibrillation (AF) occurs in 1-2% of the population in western countries and has a higher prevalence in men and older subjects [1,2,3]
This study aimed to compare the influence of preprocedural planning of the LAA closure (LAAC) with 3Dtransesophageal echocardiography (TEE) and cardiac computed tomography (CCT) versus 3D-TEE alone in patients who underwent LAAC with an Amplatzer Cardiac Plug or Amulet
There was a different incidence of renal diseases (49% for 3D-TEE versus 27% for CCT/3D-TEE; p < 0.001)

Summary

Introduction

Atrial fibrillation (AF) occurs in 1-2% of the population in western countries and has a higher prevalence in men and older subjects [1,2,3]. 90% of all thrombi develop in the left atrial appendage (LAA) [4]. In order to reduce the risk of strokes, oral anticoagulation with vitamin K antagonists (VKA) and new oral anticoagulants (NOACs) is a validated treatment [8, 9]. The use of oral anticoagulants (OACs) increases the risk of intracerebral and gastrointestinal bleeding [10,11,12,13]. The use of the clinical scores, HAS-BLED and CHA2DS2-VASc score, help to balance the risk of strokes and major bleeding in patients with AF [14, 15]. Interventional closure of the LAA (LAAC) has been shown to be a valid alternative in patients with a contraindication against OACs [16, 17]

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