Key result
Volume loading expands LAA maximal diameter by ~5% and improves device sizing accuracy.
Why the study?
Correct sizing of a left atrial appendage closure system is important to avoid device redeployment and peri-device leaks, but the optimal imaging modality and impact of volume loading on LAA size are unclear.
Does real-time 3D-TEE improve sizing accuracy for LAA closure devices compared to 2D-TEE and angiography, and does volume loading affect LAA dimensions?
Observational (n=46)
Does real-time 3D-TEE improve sizing accuracy for LAA closure devices compared to 2D-TEE and angiography, and does volume loading affect LAA dimensions?
Absolute Event Rate: 2.3% vs 2.2%
p-value: p=<0.01
Real-time 3D-TEE provides superior sizing accuracy for LAA closure devices compared to 2D-TEE and angiography, and pre-procedural volume loading significantly increases LAA dimensions.
RT 3D-TEE with volume loading may aid LAA sizing; hypothesis-generating and requires randomized validation before practice change.
AIMS: Correct sizing of a left atrial appendage (LAA) closure system is important to avoid redeployment of the device and peri-device leaks. The aims of this study were to assess the significance of two-dimensional transoesophageal echocardiography (2D-TEE), real-time 3D transoesophageal echocardiography (RT 3D-TEE) and angiography for measuring the size of the LAA landing zone and to determine the impact on sizing an LAA closure device. Furthermore, we investigated the relevance of volume loading on LAA size. METHODS AND RESULTS: In a prospective study, 46 patients underwent 2D-TEE and RT 3D-TEE 24 hours prior to LAA closure, at the beginning of the procedure and just before the procedure after volume loading with an average of 1,035±246 ml. Angiography was performed immediately before the implantation. Maximal diameter (2.2±0.4 versus 2.3±0.4 cm; p<0.01), perimeter (6.5±1.0 versus 6.8±1.0 cm, p<0.01) and area (3.2±1.0 versus 3.5±1.1 cm², p<0.01) of the LAA increased significantly after volume loading. The highest correlation (R) between measurements and LAA device size was found for RT 3D-TEE-derived perimeter (R=0.97) and area (R=0.96), whereas the maximal diameter (R=0.78) measured by 2D-TEE and angiography (R=0.76) correlated less closely. Sizing based on an RT 3D-TEE-measured perimeter resulted only in 4% of undersizing the implanted device. Peri-device leaks occurred in seven cases (15%) and were associated with a lower compression of LAA devices (7±1.3% versus 14±3.2% for patients without leaks, p<0.001). CONCLUSIONS: Volume loading before LAA closure increases LAA dimensions significantly. RT 3D-TEE measurements show a closer correlation to LAA closure device size than 2D-TEE or angiographic measurements.
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Al‐Kassou et al. (2017) conducted an observational in Left atrial appendage closure (n=46). Volume loading and RT 3D-TEE vs. Baseline (pre-volume loading) and 2D-TEE/angiography was evaluated on Maximal diameter of the LAA before and after volume loading (p=<0.01). Volume loading before LAA closure significantly increased LAA maximal diameter (2.2 vs 2.3 cm, p<0.01), and RT 3D-TEE correlated more closely with device size than 2D-TEE or angiography.
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