Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure

Abstract

CCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion.

Device‐associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet

“…The diagnosis was based in most cases by TEE FU imaging. Some cases were found on routine CT , one case was suspected on transthoracic echocardiogram (TTE) , and one case was only discovered during coronary artery bypass graft surgery, as it was not seen on previous TTE or TEE .…”

“…Diagnosis was made in most cases based on FU TEE as it is the most widely used FU modality. CCTA has also been shown to be an effective surveillance modality . It is important to note that the number of imaging FU performed was significantly correlated with the incidence of DAT.…”

Role of Imaging in Left Atrial Appendage Occlusion

“…In WATCHMAN cases, leaks are mostly eccentric and secondary to an edge effect. For ACP/Amulet cases, higher proportion of off-axis lobes were found in cases of patent LAA [31,32] and leaks were more frequent when lobe compression was ≤ 10% [33]. In the presence of peri-device leak ≥5mm, resuming or pursuing antithrombotic therapy or further intervention may be considered.…”

“…Recently, Main et al have proposed consensus echocardiographic diagnostic criteria for DAT diagnosis: echo density on the LA aspect of the device (1) not explained by imaging artefact; (2) inconsistency with normal healing/device incorporation; (3) visible in multiple TOE planes, (4) in contact with the LAA occluder device; and (5) exhibiting independent motion [53]. CCTA is also able to detect DAT or thrombus on the adjacent LA wall [32].…”

Imaging for percutaneous left atrial appendage closure

“…CCTA for ACP device follow‐up has been shown to be more reliable than transthoracic echocardiography for assessment of device position and function of ACP . A recent published series by our group included 45 patients with CCTA post LAA closure with the ACP, Amulet and WATCHMAN devices . This case series showed that greater device lobe compression and proper alignment was associated with subsequent complete LAA closure with the ACP and/or Amulet device.…”