Key result
Percutaneous left atrial appendage occlusion with devices such as Watchman and Amplatzer is noninferior to warfarin or direct oral anticoagulants for stroke prevention in atrial fibrillation patients.
Why the study?
Multimodality imaging for percutaneous endocardial left atrial appendage occlusion is rapidly evolving, requiring thoughtful integration of TEE, CCT, and ICE to optimize procedural outcomes and minimize complications.
Effect estimate: Noninferior to warfarin or direct oral anticoagulants in preventing thromboembolic events (PROTECT-AF, PREVAIL, AMULET IDE, PRAGUE-17 trials)
The thoughtful integration of advanced imaging modalities like CCT and ICE alongside traditional TEE enhances procedural efficiency and clinical outcomes in left atrial appendage occlusion.
This review summarizes the current and evolving landscape of multimodality imaging for percutaneous endocardial left atrial appendage occlusion (LAAO) across three phases: preprocedural planning, periprocedural guidance, and postprocedural follow-up. Transesophageal echocardiography (TEE) remains the primary imaging modality to assess the left atrial appendage (LAA) in all three phases of clinical care surrounding LAAO, though many innovations have led to the rise of cardiac computed tomography (CCT) and intracardiac echocardiography (ICE) as powerful adjuncts and alternatives to TEE. Advances in CCT technology such as fusion imaging and three-dimensional (3D) modeling have contributed to the emergence of CCT as an alternative to TEE for preprocedural evaluation. Intraprocedurally, real-time 3D ICE offers similar real-time guidance to TEE with similar procedural efficacy while employing a simplified workflow that can reduce procedural times and staffing needs. Post-procedural assessment with TEE or CCT is essential for evaluating device stability and complications such as peridevice leak or device-related thrombus. Multimodality imaging of LAAO is a rapidly evolving field, and thoughtful integration of TEE, CCT, and ICE is critical to optimize LAAO outcomes and minimize procedural complications.
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Ho et al. (2026) conducted a review in Atrial fibrillation patients undergoing left atrial appendage occlusion. Left atrial appendage occlusion devices (Watchman and Amplatzer) vs. Oral anticoagulation (warfarin or direct oral anticoagulants) was evaluated on Reduction in thromboembolic events and stroke risk (Noninferior to warfarin or direct oral anticoagulants in preventing thromboembolic events (PROTECT-AF, PREVAIL, AMULET IDE, PRAGUE-17 trials)). Percutaneous left atrial appendage occlusion with devices such as Watchman and Amplatzer is noninferior to warfarin or direct oral anticoagulants for stroke prevention in atrial fibrillation patients.
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