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Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

 Iksung Cho  ;  William D Kim  ;  Oh Hyun Lee  ;  Min Jae Cha  ;  Jiwon Seo  ;  Chi Young Shim  ;  Hui-Nam Pak  ;  Boyoung Joung  ;  Geu-Ru Hong  ;  Heidi Gransar  ;  Seung Yong Shin  ;  Jung-Sun Kim 
 SCIENTIFIC REPORTS, Vol.11(1) : 24107, 2021-12 
Journal Title
Issue Date
Aged ; Atrial Appendage / anatomy & histology ; Atrial Appendage / diagnostic imaging* ; Atrial Fibrillation / complications ; Atrial Fibrillation / therapy ; Female ; Humans ; Imaging, Three-Dimensional / methods* ; Ischemic Stroke / etiology ; Ischemic Stroke / prevention & control ; Male ; Middle Aged ; Preoperative Period ; Prosthesis Fitting* ; Retrospective Studies ; Septal Occluder Device* ; Tomography, X-Ray Computed / methods*
The complex structure of the left atrial appendage (LAA) brings limitations to the two-dimensional-based LAA occlusion (LAAO) size prediction system using transesophageal echocardiography. The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac computed tomography (CT); however, there is lack of data regarding which parameter to choose from CT-based images during pre-procedural planning of LAAO. We aimed to assess the accuracy of measurements derived from cardiac CT images for selecting LAAO devices. We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes. The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = - 0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = - 4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = - 1.6 ± 2.6 mm, area-derived diameter = - 2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference < 0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement. The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Seo, Jiwon(서지원) ORCID logo https://orcid.org/0000-0002-7641-3739
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Oh Hyun(이오현) ORCID logo https://orcid.org/0000-0001-7070-7720
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Cho, Ik Sung(조익성)
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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