Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review &amp; meta-analysis

Sattar, Yasar; Kompella, Ritika; Ahmad, Bachar; Aamir, Muhammad; Suleiman, Abdul-Rahman M.; Zghouzi, Mohamed; Ullah, Waqas; Zafrullah, Fnu; Elgendy, Islam Y.; Balla, Sudharshan; Kawsara, Akram; Alraies, M. Chadi

doi:10.1080/14779072.2022.2043745

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…Procedure planning is the key to minimize the risk of peri‐device leak or device‐related thrombosis. Recent studies suggested that CT‐guided procedure planning for the LAAC helped understanding of three‐dimensional LAA anatomy and provided accurate sizing of the LAA and higher procedural success as compared to TEE alone 2,3 …”

Section: Discussionmentioning

confidence: 99%

“…three-dimensional LAA anatomy and provided accurate sizing of the LAA and higher procedural success as compared to TEE alone. 2,3 On retrospective review of CT, the initial 24 mm Watchman device seemed too small for the LAA anatomy. Implantation of larger Watchman device in more proximal part of LAA would have resulted in complete sealing of LAA without peri-device leak.…”

Section: Discussionmentioning

confidence: 99%

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Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Yoon,

Elgendy,

Dallan

et al. 2023

Cathet Cardio Intervent

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Peri‐device leak after left atrial appendage closure (LAAC) is often treated with endovascular coils, plugs, or second occluders. This is the first study reporting the Amulet device used for peri‐device leak. An 80‐year‐old male with paroxysmal atrial fibrillation and recurrent falls with head trauma who underwent LAAC with a 24 mm Watchman 2.5 device 3 years ago at another institution was referred to our clinic for management of the peri‐device leak. Transesophageal echocardiogram showed persistent residual peri‐device leak with 5 mm width along the Coumadin ridge aspect of the device. Computed tomography (CT) also showed the peri‐device leak with width of 6 mm and complete opacification of left atrial appendage (LAA). Importantly, CT demonstrated that the Watchman 2.5 device was deployed at distal LAA, leaving the proximal part of LAA with length of 10 mm from ostium. Under general anesthesia, a 22 mm Amulet device was deployed successfully with complete sealing of LAA. Procedure planning is the key to minimize the risk of peri‐device leak or device‐related thrombosis. Careful assessment of LAA anatomy using multimodality images for peri‐device leak after LAAC helped optimal treatment strategy including second LAAC with different type of devices.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Yoon,

Elgendy,

Dallan

et al. 2023

Cathet Cardio Intervent

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“…По результатам метаанализа Y. Sattar и соавт., КТ по сравнению с ЧпЭхоКГ привела к увеличению размеров устья УЛП, повышению вероятности прогнозирования правильного размера устройства и сокращению времени рентгеноскопии у пациентов, перенёсших окклюзию УЛП с помощью устройства WATCHMAN. Не было никаких существенных различий в других процедурных исходах [35].…”

Section: принятые сокращенияunclassified

Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation

Galyautdinov

Ibragimova²,

Galeeva

2023

Kazan Med J

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Computed and magnetic resonance imaging of the heart has been widely used in recent years in patients with atrial fibrillation. They are used to determine the morphology of the heart, the presence of intracardiac thrombi, quantify the structures of the heart, thrombosis of intracardiac devices, determine tactics for surgical interventions, and other purposes. These methods of instrumental diagnostics can be used as an alternative to transesophageal echocardiography, which has a number of limitations and disadvantages compared to computed tomography and magnetic resonance imaging. Computed and magnetic resonance imaging of the heart are used to avoid invasiveness in the study of the heart, to improve the accuracy of measuring heart structures, to reduce the number of diagnostic methods used before various surgical interventions in patients with atrial fibrillation, and also, according to epidemic indications, as part of the prevention of the spread of coronavirus infection. In addition, magnetic resonance imaging allows to avoid radiation exposure to the patient. The review presents the results of studies, meta-analyses of pooled samples, as well as a description of the clinical possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation. Publications on the use of these methods for visualization of thrombi in the left atrium and its appendage, in pulmonary vein ablation and occlusion of the left atrial appendage, as well as data on visualization of the residual flow around the occlusive device and thrombosis of intracardiac devices are presented. According to the results of a literature review, computed tomography and magnetic resonance imaging of the heart have similar or higher imaging capabilities compared to transesophageal echocardiography, as well as some advantages over it, primarily the non-invasiveness of the procedure. The works demonstrating the possibilities of computed tomography of the heart for the diagnosis of coronary heart disease in patients with atrial fibrillation are presented. In preparing the review, the literature search method in PubMed databases for the period 20132022 was used.

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“…However, cardiac computed tomography (CT) is used increasingly for pre-procedural imaging. Data indicate that it might lead to more successful device implantations than a TEE-guided strategy [ 7 , 11 , 12 ]. Moreover, CT can be used for printing of patient-specific 3D-models of the LAA or simulation of implant result [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography–based device-sizing in Amplatzer Amulet left atrial appendage occlusion

Nirmalan,

Kramer,

Korsholm

et al. 2023

J Interv Card Electrophysiol

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Background Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing. Methods Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1–3) along with the underlying mechanism. Results Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), − 0.39 mm (± 2.43), and − 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment. Conclusion Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter. Graphical Abstract

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Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review & meta-analysis

Cited by 5 publications

References 26 publications

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation

Computed tomography–based device-sizing in Amplatzer Amulet left atrial appendage occlusion

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Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review & meta-analysis

Cited by 5 publications

References 26 publications

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

Possibilities of computed and magnetic resonance imaging of the heart in patients with ­atrial fibrillation

Computed tomography–based device-sizing in Amplatzer Amulet left atrial appendage occlusion

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Product

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Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation