Key result
Cardiac computed tomography provided the most accurate landing zone measurements (mean 20.60 mm) compared to TEE (18.72 mm), ICE, and fluoroscopy, matching final device selection in 92% of patients.
Why the study?
LAAC carries a high risk of complications, and proper device sizing is often difficult due to the complex anatomy of the LAA and its oval-shaped ostium.
Does pre-procedural cardiac CT improve landing zone measurement accuracy and device size selection compared to TEE, ICE, and fluoroscopy in patients undergoing left atrial appendage closure?
Observational (n=25)
No
Does pre-procedural cardiac CT improve landing zone measurement accuracy and device size selection compared to TEE, ICE, and fluoroscopy in patients undergoing left atrial appendage closure?
Absolute Event Rate: 20.6% vs 18.72%
p-value: p=<0.001
Pre-procedural cardiac CT provides more accurate landing zone measurements for left atrial appendage closure device sizing compared to TEE, ICE, and fluoroscopy, matching final device selection in 92% of cases.
May support CT for more accurate LAA device sizing; leaves open outcome benefits versus TEE/fluoroscopy in RCTs.
BACKGROUND: Left atrial appendage (LAA) closure (LAAC) is accompanied by a high risk of complications. Due to the complex anatomy of the LAA and the oval-shaped ostium, the proper sizing of the device is often difficult. PURPOSE: To assess individualized fluoroscopy viewing angles using pre-procedural CT analysis and to compare the results of landing zone measurements obtained from CT, transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and fluoroscopy. METHODS: Patients with indications for LAAC were enrolled. Cardiac CT and TEE were done before the procedure; ICE and fluoroscopy measurements were done peri-procedurally. Multiplanar reconstruction of CT images, using FluoroCT software, was done, and optimal "personalized" viewing angles for fluoroscopy were determined. Moreover, a mean (using multiplanar CT reconstruction, derived from the LAA perimetr) amd maximum (using all four imaging modalitities) landing zone (LZ) of the LAA were masured. RESULTS: Twenty-five patients were analyzed. Despite significant correlation between LZs obtained from different imaging modalities, the values of LZs differed significantly; the mean LZ diameter on CT was 20.60 ± 3.42 mm, the maximum diameters were 21.99 ± 4.03 mm (CT), 18.72 ± 2.44 mm (TEE), 18.20 ± 2.68 mm (ICE), and 17.76 ± 3.24 mm (fluoroscopy). The mean CT diameter matched with the final device selection in 92% patients, while fluoroscopy or TEE maximum diameters in only 72% patients. Optimal viewing angles differed significantly from the fluoroscopy projections usually recommended by the manufacturer in 3 patients. CONCLUSIONS: CT provides the best measurement of the LZ and the best prediction of the optimum fluoroscopy projections for the implantation procedure.
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A 2020 study conducted an observational in Atrial Fibrillation (n=25). Cardiac Computed Tomography (cCT) vs. Transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and fluoroscopy was evaluated on Landing zone diameter measurement (p=<0.001). Cardiac computed tomography provided the most accurate landing zone measurements (mean 20.60 mm) compared to TEE (18.72 mm), ICE, and fluoroscopy, matching final device selection in 92% of patients.
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