Key result
CTA-based preprocedural sizing for the WATCHMAN FLX device accurately predicted the implanted size in 91.1% of patients and achieved a 98.5% procedural success rate.
Why the study?
Device sizing for LAAC can be challenging, and there is limited published experience regarding noninvasive CTA-based sizing strategies.
Does a novel CTA-based sizing methodology for the WATCHMAN FLX device improve safety and feasibility in patients undergoing left atrial appendage closure?
Observational (n=136)
No
Does a novel CTA-based sizing methodology for the WATCHMAN FLX device improve safety and feasibility in patients undergoing left atrial appendage closure?
CTA-based preprocedural sizing for the WATCHMAN FLX device using TruPlan software is safe, feasible, and accurately predicts implanted device size in over 90% of cases.
CTA-based LAAC sizing appears feasible; leaves open superiority to TEE in randomized trials.
BACKGROUND: While there is recent data suggesting an advantage of computed tomography angiography (CTA) over transesophageal echocardiography (TEE) for preprocedural left atrial appendage closure (LAAC) planning, there is limited published experience for sizing strategies. Device sizing for LAAC may be challenging and noninvasive algorithms that improve this selection process are warranted. OBJECTIVES: We sought to evaluate the safety and the feasibility for the implementation of a novel CTA-based sizing methodology for WATCHMAN™ FLX device in a series of patients undergoing LAAC using the TruPlan™ software package. METHODS: A prospective analysis of 136 consecutive patients who underwent LAAC over a 12-month period in a single, large academic hospital in the United States was conducted. CTA-guided preprocedural planning and intracardiac echocardiography (ICE) was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. RESULTS: VASc score was 4.4 ± 1.3 and the mean HAS-BLED score was 3.9 ± 0.8. ICE-guided 100% transseptal puncture success rate was 100% with 98.5% of overall procedural success rate. Preprocedural CTA sizing strategy accurately predicted the implanted size in 91.1% of patients. Ten patients (7.4%) required another sized device and 2 cases were aborted. At 45-day follow-up, only 1 patient (0.7%) had significant peri-device leak (≥5 mm) on TEE. CONCLUSIONS: CTA-based preprocedural sizing methodology for WATCHMAN™ FLX in LAAC was safe, feasible and associated with excellent procedural outcomes. Further studies are warranted to confirm if the features specific to TruPlan™ may reduce the number of deployment attempts, the number of devices utilized in the procedure, and the risk of complications.
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Dallan et al. (2022) conducted an observational in Atrial fibrillation requiring left atrial appendage closure (n=136). CTA-based sizing methodology for WATCHMAN FLX device was evaluated on Overall procedural success rate. CTA-based preprocedural sizing for the WATCHMAN FLX device accurately predicted the implanted size in 91.1% of patients and achieved a 98.5% procedural success rate.
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