Multimodality Imaging for Optimal Device-size Selection During Percutaneous Left Atrial Appendage Closure in Thai Population

Background: Optimal device size selection is crucial for percutaneous left atrial appendage (LAA) closure. Transesophageal echocardiography (TEE) is the standard imaging technique for LAA assessment, however there are discrepancies among different imaging modalities. We aimed to evaluate the agreement between device size and LAA size measured by three methods: multi-detector cardiac computed tomography (MDCT), TEE, and angiography. Methods: Patients who underwent percutaneous LAA closure at King Chulalongkorn Memorial Hospital from 2012 to 2020 were included in this study. MDCT, TEE and angiography were reviewed. LAA ostial diameter, landing zone diameter and maximal depth from each imaging modality was measured and analyzed. Agreement between landing zone diameter and implanted device size was assessed.Results: We reported on 61 consecutive patients who underwent percutaneous LAA closure. The mean age of patients was 74.0 ± 8.4 years. The mean CHA2DS2 score, CHA2DS2-VASc score and HAS-BLED score were 2.8 ± 1.4, 4.6 ± 1.8 and 2.6 ± 1.0, respectively. Device implantation was successful in all patients (100%). Two different LAA closure devices were used: Watchman (n = 43, 70.5%) and Omega (n = 18, 29.5%). Maximum landing zone diameter measured by MDCT scan, TEE and angiography were 23.4 ± 3.9 mm, 22.2 ± 4.8 mm and 22.7 ± 3.5 mm, respectively. MDCT measurement was significantly larger than TEE measurement (p = 0.015) and closer to implanted device size compared with TEE and angiography. The difference between landing zone diameter measured by CT scan and device size was -1.65 ± 2.0 mm compared with -4.8 ± 4.6 mm for TEE and -4.3 ± 3.3 mm for angiography.Conclusion: MDCT sizing of LAA results in larger measurement than TEE. Routine implementation of MDCT sizing may improve procedural success with more accurate device size selection.