Key result
Additional preprocedural CT planning for Watchman implantation was associated with a higher successful device implantation rate compared to stand-alone TEE guidance (98.5% vs 94.9%; P=0.02).
Why the study?
Transesophageal echocardiogram is standard preprocedural imaging for left atrial appendage occlusion, but the additive value of preprocedural CT planning remained to be assessed.
Does additional preprocedural computed tomography (CT) planning improve the rate of successful device implantation without major peri-device leak in patients undergoing Watchman left atrial appendage occlusion compared to stand-alone transesophageal echocardiogram guidance?
Cohort (n=485)
No
Does additional preprocedural computed tomography (CT) planning improve the rate of successful device implantation without major peri-device leak in patients undergoing Watchman left atrial appendage occlusion compared to stand-alone transesophageal echocardiogram guidance?
Absolute Event Rate: 98.5% vs 94.9%
p-value: p=0.02
Preprocedural CT planning for Watchman left atrial appendage occlusion improves procedural success rates and reduces procedural time compared to TEE guidance alone.
CT planning was associated with higher LAAO success and efficiency; leaves open need for randomized trials before practice change.
Background Transesophageal echocardiogram is currently the standard preprocedural imaging for left atrial appendage occlusion. This study aimed to assess the additive value of preprocedural computed tomography (CT) planning versus stand‐alone transesophageal echocardiogram imaging guidance to left atrial appendage occlusion. Methods and Results We retrospectively reviewed 485 Watchman implantations at a single center to compare the outcomes of using additional CT preprocedural planning (n=328, 67.6%) versus stand‐alone transesophageal echocardiogram guidance (n=157, 32.4%) for left atrial appendage occlusion. The primary end point was the rate of successful device implantation without major peri‐device leak (>5 mm). Secondary end points included major adverse events, total procedural time, delivery sheath and devices used, risk of major peri‐device leak and device‐related thrombus at follow‐up imaging. A single/anterior‐curve delivery sheath was used more commonly in those who underwent CT imaging (35.9% versus 18.8%; P <0.001). Additional preprocedural CT planning was associated with a significantly higher successful device implantation rate (98.5% versus 94.9%; P =0.02), a shorter procedural time (median, 45.5 minutes versus 51.0 minutes; P =0.03) and a less frequent change of device size (5.6% versus 12.1%; P =0.01), particularly device upsize (4% versus 9.4%; P =0.02). However, there was no significant difference in the risk of major adverse events (2.1% versus 1.9%; P =0.87). Only 1 significant peri‐device leak (0.2%) and 5 device‐related thrombi were detected in follow‐up (1.2%) with no intergroup difference. Conclusions Additional preprocedural planning using CT in Watchman implantation was associated with a higher successful device implantation rate, a shorter total procedural time, and a less frequent change of device sizes.
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A 2021 study conducted a cohort in Left atrial appendage occlusion (n=485). Preprocedural computed tomography (CT) planning vs. Stand-alone transesophageal echocardiogram guidance was evaluated on Successful device implantation without major peri-device leak (>5 mm) (p=0.02). Additional preprocedural CT planning for Watchman implantation was associated with a higher successful device implantation rate compared to stand-alone TEE guidance (98.5% vs 94.9%; P=0.02).
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