Key result
Preoperative planning using CCTA for left atrial appendage occlusion increased the first-attempt blocking success rate compared to TEE and fluoroscopy alone (85.9% vs 65.6%, P=0.021).
Why the study?
To evaluate the value of individualized planning of left atrial appendage occlusion using cardiac computed tomography angiography reconstruction techniques.
Does preoperative planning using CCTA improve procedural efficiency and success in patients undergoing LAAO?
RCT (n=96)
2:1 ratio
Does preoperative planning using CCTA improve procedural efficiency and success in patients undergoing LAAO?
Absolute Event Rate: 85.9% vs 65.6%
p-value: p=0.021
Preoperative CCTA planning for LAAO improves procedural efficiency and first-attempt success rates compared to standard TEE and fluoroscopy guidance.
CCTA planning may enhance LAAO precision in small cohorts; leaves open need for larger outcome trials before practice change.
Objective. To evaluate the value of individualized planning of left atrial appendage occlusion (LAAO) using cardiac computed tomography angiography (CCTA) reconstruction techniques. Methods. A total of 96 patients treated for LAAO with the Watchman occluder were included in this study. All patients were randomized by random number table in a 2:1 ratio into the CCTA (+) and CCTA (−) groups according to whether CCTA was performed preoperatively. 3D cardiac reconstruction was performed preoperatively in the CCTA (+) group to plan the location of the atrial septal puncture site, left atrial appendage(LAA) landing zone, predict the size of the occluder and simulate occluder release. In the CCTA(−) group, only transesophageal echocardiography (TEE) and fluoroscopy were used to guide LAAO. Results. The number of occluders used in a single procedure (1.06 ± .24 vs 1.22 ± .42), the number of intraoperative angiography positions (1.23 ± .58 vs 2.28 ± .85) and the procedure time (45.88 ± 5.08 vs 62.44 ± 5.60) in the CCTA(+) group were lower than in the CCTA(−) group ( P < .05), and the first-attempt blocking success rate was higher than that of the CCTA(−) group (85.9% vs 65.6%, P = .021). Furthermore, the Bland-Altman plots showed good agreement between the longest diameter of the CCTA-predicted landing zone and the longest diameter of the actual landing zone (95% LoA −7.49, 10.24). A strong positive correlation was observed between the predicted compression ratio and the actual compression ratio (r = .890, P < .001). In addition, a strong positive correlation was found between the CCTA-predicted longest diameter of the landing zone and the actual occluder size (r = .863, P < .001). Conclusion. Accurate planning for LAAO using preoperative CCTA can reduce intraoperative angiography positions and occluder changes, shorten the procedure time, increase the success rate of first-attempt blocking and reduce the difficulty of the procedure.
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Wang et al. (2023) conducted an RCT in Left atrial appendage occlusion (LAAO) (n=96). Preoperative planning using cardiac computed tomography angiography (CCTA) vs. Transesophageal echocardiography (TEE) and fluoroscopy only was evaluated on First-attempt blocking success rate (p=0.021). Preoperative planning using CCTA for left atrial appendage occlusion increased the first-attempt blocking success rate compared to TEE and fluoroscopy alone (85.9% vs 65.6%, P=0.021).
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