Application of 3-Dimensional Computed Tomographic Image Guidance to WATCHMAN Implantation and Impact on Early Operator Learning Curve

Abstract

Three-dimensional CT image case planning provides a comprehensive and customized patient-specific LAA assessment that appears to be accurate and may possibly facilitate reducing the early WATCHMAN implantation learning curve.

Prospective, randomized comparison of 3‐dimensional computed tomography guidance versus TEE data for left atrial appendage occlusion (PRO3DLAAO)

“…Variable loading conditions, appendage contractile cycle, and individualized anatomy all play a role in making 2D LAA measurements inaccurate and can be overcome with CT . Similar to our preliminary study, CT LAA widest measurement exceeded 2D‐TEE measurements by a mean of 1.83 ± 0.9 and 2.6 ± 2.3 mm in the CT and 2D‐TEE cohorts respectively and 2.2 ± 1.8 mm for the entire cohort which is comparable to the results from our pilot study (2.7 ± 2.2 mm) . This calls into question the current sizing guidelines in the IFU and prompts the discussion of a possible revision of the guidelines or possibly choosing an alternate imaging modality for occluder sizing.…”

“…CT scanning protocol, generation of the 3D rendering and data extraction has all been previously described . Briefly, preprocedure imaging utilized a contrast‐enhanced, retrospectively electrocardiogram‐gated CTA acquisition without ECG dose modulation using a GE Discovery CT750 (General Electric Healthcare, Waukesha, WI).…”

Transcatheter closure of the left atrial appendage: A focused update on the Watchman closure device

“…It provides superior spatial resolution with a three‐dimensional (3D) rendering that is superior to 3D‐TEE. CCTA has better accuracy for LAA sizing and decreases device use (1.245 vs. 1.8 devices) per implantation attempt compared to TEE . Furthermore, the 3D dataset can be used for 3D‐printing and in‐vitro testing for device‐selection and size .…”

Role of Imaging in Left Atrial Appendage Occlusion

“…This evaluation will gather information about presence of thrombus, LAA morphology and size, other cardiac structures and will exclude contra-indications for LAA closure. TOE is the preferred modality but alternative (in case of contraindications to TOE) or complementary imaging by CCTA is increasingly performed [9,10]. Many authors judge the presence of thrombus as an absolute contra-indication for LAA closure.…”

“…A particular value of CCTA may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurred in a small proportion of cases (3.4%) in a single-center registry [18]. In most studies, CCTA most often predicts the appropriate device size [10,17,19]. The use of real time 3D TOE for the visualization and quantitative analysis of LAA parameters is more frequent and has several advantages.…”