Usefulness of preprocedural 3-dimensional computed tomography planning in assisting one-stage pulmonary veins isolation with concomitant left atrial appendage occlusion procedure: A pilot study
Year: 2024
Type: article
Abstract: Background: The optimal imaging modality for selecting the device size in patients with atrial fibrillation undergoing one-stop left atrial appendage occlusion (LAAO) with concomitant pulmonary vein isolation (PVi) remains undefined. We compared preprocedural 3-dimensional computed tomography (3D CT) with intra-procedural transesophageal echocardiography (TEE) and left atrial appendage (LAA) angiography in guiding one-stage PVi and LAAO. Methods: We measured the LAA ostium diameter using an interactive 3D CT system with a central line-based approach and compared these measurements with those from intra-procedural TEE and angiography, and the actual device size. The optimal compression ratio was used to assess the attainment rates of the three imaging modalities. Results: Twenty-two patients (median age: 68.5 years, 21.8 % female) underwent the one-stage procedure. The median LAA ostium diameter measured by 3D CT (24.3 mm, interquartile range [IQR] = 22.0-27.0 mm) was closer to the Watchman device size (27.0 mm, IQR = 24.0-31.0 mm, P = 0.127) compared to TEE (21.2 mm, IQR = 18.4-22.7 mm, P < 0.001) and angiography (22.5 mm, IQR = 17.9-25.1 mm, P < 0.001). 3D CT had a better attainment rate for the optimal compression ratio than TEE (10.8 %, IQR = 7.4-16.5 % vs. 22.7 %, IQR = 19.2-29.3 %, P < 0.001) and angiography (19.7 %, IQR = 15.1-24.1 %, P = 0.001). All patients underwent successful device implantation without peri-device leak or complications during the periprocedural period and follow-up. Conclusions: In this pilot study, a preprocedural central line-based 3D CT planning system appeared to be more effective than intraoperative TEE and angiography in measuring the LAA ostium diameter to guide device size selection in patients with atrial fibrillation undergoing one-stop LAAO with concomitant PVi.
Source: IJC Heart & Vasculature
Authors: Ke-Wei Chen, Yen-Nien Lin, Mei-Yao Wu, Yi-Hsiu Wu, Wen-Sheng Feng, Ping-Han Lo, Wei-Hsin Chung, Cheng-Chang Tung, Kuan-Cheng Chang
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,930
Awards: Exploring the Triggers of Primary Ventricular Tachyarrhythmias in St-Elevation Myocardial Infarction: Focusing on the L5-Lox-1 Pathway and Genetic Risk Factors Identified by Whole Transcriptome Analysis and Genome-Wide Association Study, G1732532146, Younger Patients Are Associated with Higher Risk of Primary Ventricular Tachycardia/Ventricular Fibrillation in St-Elevation Myocardial Infarction: Role of L5-Lox-1 Signaling, G3677284626, G3705681740, G5459725191, G7579310749, G8512037182
OpenAlex ID: W4405889470