Imaging for percutaneous left atrial appendage closure

Prakash, Roshan; Saw, Jacqueline

doi:10.1002/ccd.26828

Cited by 9 publications

(2 citation statements)

References 38 publications

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“…Furthermore, 3D reconstructions from cardiac CT may improve LAAO device sizing which may translate to improved procedural success and reductions in PDL. 22,25 However, neither TEE nor CT provides quantitative information regarding the degree of PDL or residual device permeability which may be a critical factor in the prognostic significance of PDL on thrombotic risk.…”

Section: Incidence Of Pdl: Impact Of Diagnostic Modalitymentioning

confidence: 99%

Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs

et al. 2020

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Oral anticoagulation reduces the ischemic stroke risk in patients with nonvalvular atrial fibrillation (NVAF) but inherently increases the bleeding risk. Percutaneous left atrial appendage occlusion (LAAO) offers an alternative to long-term anticoagulation in patients at risk for cardioembolic events due to underlying atrial fibrillation. Although long-term clinical data remain limited, percutaneous LAAO appears to be a safe and effective means of reducing hemorrhagic stroke and non-procedural-related bleeding events compared to warfarin. Incomplete closure of the LAA resulting in a peri-device leak (PDL) is common after interventions targeting the LAA and has been variably associated with an increased risk of embolic stroke in patients following LAAO. However, the clinical significance of PDL remains unclear, in part, due to variability in the definitions used for PDL, modalities used for the detection of PDL, and the confounding impact of continuing therapeutic anticoagulation in patients found to have PDL on surveillance imaging. In the current review, we examine the association of PDL with ischemic stroke and systemic embolization and explore mechanistic considerations in the development of PDL as they pertain to the unmet need for improving the diagnostic assessment of PDL from an anatomic and physiologic perspective.

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Section: Incidence Of Pdl: Impact Of Diagnostic Modalitymentioning

confidence: 99%

Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs

et al. 2020

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“…In recent years, left atrial appendage occlusion (LAAO) has gradually become an effective means to prevent stroke in patients with AF, so as to avoid the disadvantages caused by long-term oral anticoagulants [1][2][3] .The LAAO is safe, and with the maturity of experience and improvement of preoperative planning, the success rate of LAAO is significantly improved. Transesophageal echocardiography (TEE) is the preferred imaging method for detecting thrombus before LAAO and guiding LAAO during operation, and it can be used as an independent imaging tool for LAAO [4] . However, TEE usually requires general anesthesia (GA), an experienced ultrasound physician, and has some damage to patients as an invasive examination [5] .…”

Section: Introductionmentioning

confidence: 99%

Comparing Measurements of Intracardiac Echocardiography and Other Periprocedural Imaging of the Left Atrial Appendage For Percutaneous Occlusion

Liu

You

et al. 2021

Preprint

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Background: Intracardiac echocardiography (ICE) has recently been used as a safe and feasible imaging to guide left atrial appendage occlusion (LAAO). However, there is no good comparison of the correlation of left atrial appendage (LAA) measurements between ICE, transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy. Methods: We compared the correlation between ICE and CCTA, TEE, fluoroscopy on two key LAA measurements of each patient: (1) Lambre measured the landing zone and orifice; (2) Watchman measured the ostium and depth. Results: In this study, the success rate of operation was 100%, and no major adverse events occurred. For Lambre landing zone, mean measurements were 22.5±4.0mm with ICE, 23.5 ±4.5mm CCTA, 22.0±4.5mm TEE, 21.5±4.4mm fluoroscopy (P < 0.001). R values 0.78 ICE/CCTA, 0.85 ICE/TEE, 0.81 ICE / fluoroscopy; For Lambre orifice, mean measurements were 29.1±4.0mm with ICE, 31.0±3.9mm CCTA, 25.6±4.6mm TEE and 28.9±3.9mm fluoroscopy (P < 0.001). R values 0.68 ICE/CCTA, 0.76 ICE/TEE, and 0.75 ICE/fluoroscopy. For Watchman ostium, mean measurements were 22.7±3.2mm with ICE, 23.9±3.2mm CCTA, 21.9±3.1mm TEE, and 21.6±3.0mm fluoroscopy (P<0.001). R values 0.69 ICE/CCTA, 0.85 ICE/TEE, and 0.71 ICE/fluoroscopy; For Watchman depth, mean measurements were 22.1±3.1mm with ICE, 24.8±4.1mm CCTA, 23.7±2.9mm TEE, and 21.1±3.3mm fluoroscopy (P=0.002). R values 0.31 ICE/CCTA, 0.67 ICE/TEE, and 0.41 ICE/fluoroscopy. Conclusion: ICE from LA can be a safe and efficacious imaging option to guide LAAO, and ICE has good correlation with CCTA, TEE and fluoroscopy.

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Comparison of echocardiographic and fluoroscopic sizing of the left atrial appendage prior to percutaneous closure

Kiani

Patel

El‐Chami

et al. 2019

J Interv Card Electrophysiol

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Imaging for percutaneous left atrial appendage closure

Cited by 9 publications

References 38 publications

Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs

Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs

Comparing Measurements of Intracardiac Echocardiography and Other Periprocedural Imaging of the Left Atrial Appendage For Percutaneous Occlusion

Comparison of echocardiographic and fluoroscopic sizing of the left atrial appendage prior to percutaneous closure

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