Orly Goitein MD, Presenter: Research Grant, Koninklijke Philips Electronics NV

Grupper Avisahy, Abstract Co-Author: Nothing to Disclose

Elio Di Segni MD, Abstract Co-Author: Nothing to Disclose

Eli Konen MD, Abstract Co-Author: Nothing to Disclose

Ashraf Hamdan MD, Abstract Co-Author: Nothing to Disclose

Victor Guetta, Abstract Co-Author: Proctor, Edwards Lifesciences Corporation

Ilan Hai, Abstract Co-Author: Nothing to Disclose

David Luria MD, Abstract Co-Author: Nothing to Disclose

Michael Glikson MD, Abstract Co-Author: Nothing to Disclose

Atrial fibrillation (AF) may cause thromboembolic stroke. The left atrial appendage (LAA) is the thrombi source in more than 90% of strokes. Several devices have been developed to occlude the LAA. Inaccurate LAA orifice sizing may lead to utilization of more than one device per procedure, or inadequate LAA occlusion.   The purpose of this study was to assess the contribution of cardiac Computed Tomography (CCT) measurements for LAA device sizing with.  

All subjects underwent ECG gated CT scans prior to LAA closure device insertion. CCT scans were performed using a 256-slice scanner with retrospective electrocardiographic gating . Assessed parameters included: LAA maximal and minimal diameters (mm), LAA depth (mm). These values were compared with final implanted device size. Echocardiographic follow up at six weeks was performed in order to document the presence of regurgitation, as evidence for incomplete LAA occlusion.  

This study cohort included 22 chronic AF patients (9 males, average age 76 years). Two procedures failed, the maximal LAA diameter was 39 mm in both. The total number of devices used was 24 in 20 patients (1.2 devices per patient). Mean maximal CCT and minimal diameters were 27±5 and 22±5 mm respectively. Mean LAA depth was 22±4 mm. Mean device size was 24±4. Good correlation was found between maximal CCT diameter and device size (Pearson correlation=0.45; p=0.04). No correlation was found between minimal LAA diameter, LAA depth and device size (Pearson correlation=-0.0.08; p=0.7 and -0.02;p=0.9, respectively). LAA diameter >30 mm (N=5) was associated with adverse device sizing ; procedure failure (2/5) and incomplete LAA occlusion (2/5) with regurgitation on echocardiographic follow up.

CCT should be considered as an important adjunct modality for device sizing. LAA maximal diameter > 30 mm was predictive of unfavorable procedure outcome including procedure failure and incomplete LAA occlusion in 80% of cases with large LAA ostia.  

Cardiac CT is an important imaging modality before LAA occluder insertion. It allows accurate LAA size evaluation and can identify potential problematic cases prior to device implantation.

Goitein, O, Avisahy, G, Di Segni, E, Konen, E, Hamdan, A, Guetta, V, Hai, I, Luria, D, Glikson, M, Cardiac Computed Tomography (CCT) for Predicting Left Atrial Appendage Occluder Device Size.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028838.html