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Cardiac CT Angiography (CCTA) predicts left atrial appendage occluder device size and procedure outcome

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Abstract

Aim

To investigate the role of cardiac CT angiography (CCTA) in predicting optimal left atrial appendage (LAA) occluder size and procedure outcome.

Methods and results

Thirty-six patients underwent pre-procedural CCTA. CCTA and TEE LAA orifice diameters and perimeters were compared with the implanted device size. CCTA 3D configuration was correlated with procedure outcome. Watchman™ device (N = 18): diameters were 21 ± 4, 26 ± 5 and 25 ± 3 mm for TEE, CCTA and inserted device, respectively. Average perimeters were 61 ± 10, 74 ± 8 and 78 ± 11 mm for TEE, CCTA and inserted device, respectively. Better agreement with the device size was found for CCTA compared to TEE (Bland–Altman). ACP™ device (N = 15): diameters were 20 ± 5, 25 ± 4 and 23 ± 4 for TEE, CCTA and inserted device, respectively. Average perimeters were 58 ± 11, 72 ± 15 and 72 ± 13 mm for TEE, CCTA and inserted device, respectively. Excellent correlation and agreement with the device size was found for CCTA compared to TEE. CCTA perimeter >100 mm and “cactus” 3D configuration had a specificity of 96 and 81% respectively for procedure failure.

Conclusions

CCTA LAA ostial perimeter predicted better the optimal occluder size as compared with the currently used LAA TEE diameter. Moreover, CCTA 3D data may help in predicting potential complications.

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Acknowledgements

The authors would like to thank Ilia Novikov for his contribution in the statistical analysis.

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Author notes

    Authors and Affiliations

    1. Department of Diagnostic Imaging, Chaim Sheba Medical Center, 52621, Ramat Gan, Israel

      Orly Goitein, Elio Di Segni, Yafim Brodov & Eli Konen

    2. Heart Center, Chaim Sheba Medical Center, 52621, Ramat Gan, Israel

      Noam Fink, Ilan Hay, Victor Guetta, Yafim Brodov & Michael Glikson

    3. Department of Surgery C, Chaim Sheba Medical Center, 52621, Ramat Gan, Israel

      David Goitein

    4. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

      Orly Goitein, Noam Fink, Ilan Hay, Elio Di Segni, Victor Guetta, David Goitein, Yafim Brodov, Eli Konen & Michael Glikson

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    1. Orly Goitein
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    Correspondence to Orly Goitein.

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    Noam Fink contributed equally contributed to this work.

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    Goitein, O., Fink, N., Hay, I. et al. Cardiac CT Angiography (CCTA) predicts left atrial appendage occluder device size and procedure outcome. Int J Cardiovasc Imaging 33, 739–747 (2017). https://doi.org/10.1007/s10554-016-1050-6

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    • DOI: https://doi.org/10.1007/s10554-016-1050-6

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