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Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion

 Yeong-Min Lim  ;  Jung-Sun Kim  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Chi Young Shim  ;  Boyoung Joung  ;  Geu-Ru Hong  ;  Moon-Hyoung Lee  ;  Yang-Soo Jang  ;  Hui-Nam Pak 
 JOURNAL OF CARDIOLOGY, Vol.70(6) : 571-577, 2017 
Journal Title
Issue Date
Aged ; Atrial Appendage/diagnostic imaging* ; Atrial Appendage/physiopathology* ; Echocardiography, Transesophageal/methods ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome
Computed tomogram ; Contrast-filling ; Left atrial appendage ; Stroke
BACKGROUND: The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO.

METHODS: We included 35 patients (age 67.5±10.9 years, CHA2DS2VASc 4.2±1.6, HAS-BLED 3.7±1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4%) underwent multiple episodes of CT follow-up.

RESULTS: 1. The proportions of patients with LAA-CF were 54.2% (19/35) at 6 months, 55.5% (5/9) at 6-18 months, and 33.3% (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8±1.5 months (66.6% in WATCHMAN and 36.3% in ACP; p=0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0±11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08-1.96), p=0.013, adjusted for age, sex, and device type].

CONCLUSIONS: Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Yang, Pil Sung(양필성)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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