Author + information
- Sofia Chatzikyriakou,
- Etel Silva Garcia,
- Martin Penicka,
- Guy Van Camp,
- Peter Geelen and
- Tom De Potter
Introduction: Left atrial appendage (LAA) occlusion procedure is mainly facilitated by the use of two-dimensional transoesophageal echocardiography (TEE) combined with fluoroscopy for the assessement of the LAA anatomy and appropriate device selection. Alternatively, three dimensional rotational angiography (3DRA) is an innovative method that allows reconstruction of the LAA volume with high accuracy in real time, providing detailed anatomy of the LAA.
We sought to demonstrate the utility and safety of 3DRA in providing adequate guidance as an alternative to TEE during the percutaneous LAA occlusion procedure.
Methods: We prospectively enrolled 20 consecutive patients who were planned for LAA closure with a Watchman device. The operator was blinded to TEE images and the entire procedure was guided by 3DRA. In parallel, TEE imaging was performed to compare to 3DRA measurements and to serve as a safety backup. All patients underwent TEE 3 months post implantation to assess peri-device leak, thrombus formation and device dislodgement.
Results: The device was successfully implanted in 18/19 patients (1 failure due to lack of sufficiently large device and 1 aborted due to access problem in extreme obesity). Average age was 76±7 years and mean CHA2DS2VASc 5±2. The mean maximum LAA ostial diameters were 20.7±3mm with TEE versus 24.2±4.5mm with 3DRA (p<0.05 R2=0.59). In all cases largest diameters were obtained by 3DRA. Calculated device compression using 3DRA dimensions was 11±8 % versus 22±8 % using TEE dimensions. In 14 cases (70%), following standard device instructions, TEE dimensions would have resulted in device compression < 8% if compared to the 3DRA dimensions (in 11 cases (55%), 0%). There were no safety issues. TEE follow up revealed peri-device flow in 5 patients (in all cases jet width ≤0.5cm). No thrombus or device dislodgement was observed.
Conclusions: 3DRA is a novel imaging tool providing highly accurate ostial measurements and an alternative to TEE for LAA occlusion procedural guidance. Improved accuracy of 3DRA may lead to better device selection and avoidance of significant device undersizing.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Expanding Clinical Applications
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1161-241
- 2017 American College of Cardiology Foundation