Author + information
- David McNeely,
- Kim L. Sandler,
- Michael Baker and
- Christopher Ellis
Background: The WATCHMAN left atrial appendage occluder (LAAO) prevents thromboembolism in non-valvular atrial fibrillation patients. Transesophageal echocardiography (TEE) is the recommended modality for preoperative sizing of the LAA and thrombus exclusion. Patients evaluated for WATCHMAN with available computed tomography angiography (CTA) were included for analysis.
Methods: All patients (n=63) undergoing WATCHMAN implant at Vanderbilt Hospital were identified. Of these, n=18 also had CTA imaging. TEE measurements were performed for ostial width and depth at 0,45,90 and 135 degree views. For CTA, LAA measurements were taken in orthogonal views, including 3D reconstruction of the LAA orifice. Predicted device size was determined by TEE measurements, CTA orthogonal measurements and 3D CTA. Predicted size was compared to the actual device size at implant, and sizing error was determined (Table 1).
Results: Orthogonal CTA measurements estimated LAA size significantly better than TEE (average error of 0.5 sizes, compared to an average error of 1.44 sizes with TEE, p=0.012). 3D CTA reconstruction did not offer increased accuracy compared to orthogonal CTA measurements (average error of 0.61 sizes, p=0.67). LAA thrombus was suspected in n=4 patients on CTA with thrombus confirmed in n=2 by TEE.
Conclusions: Cross-sectional and 3D CTA imaging of the LAA ostium are able to more accurately assess LAA size for WATCHMAN device implantation. Assessment of LAA thrombus is less specific by CTA compared to TEE.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Structural Heart Interventions: Focus on Mitral Valve, Left Atrial Appendage and HOCM
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1156-175
- 2017 American College of Cardiology Foundation