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Assessment of peri-device leaks after interventional left atrial appendage closure using standardized imaging by cardiac computed tomography angiography

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Abstract

Cardiac computed tomography angiography (cCTA) has recently been proposed for evaluation of successful interventional left atrial appendage closure (LAA/LAAC). This prospective longitudinal observational study aims to assess this proposal by applying a standardized imaging protocol to detect and quantify peri-device leaks (PDL) after LAAC. cCTA datasets of consecutive patients 6 months after successful LAAC were acquired on a third generation dual-source computed tomography system and reconstructed with a slice thickness of 0.5 mm. The standardized multi-planar reconstruction LAA occluder view for post-implantation evaluation (LOVE) algorithm was used to assess PDL in relation to LAA morphology and implanted LAAC devices. A total of 49 patients (median age 80 years, 24% female) were included consecutively. Overall PDL rate was 31%. Leak rates among different left atrial appendage morphologies varied largely. Windsock type had the highest incidence of PDL (47%). AMPLATZER™ AMULET™ device type revealed slightly higher PDL rates than WATCHMAN™ type and showed larger leaks. However, no statistical differences were found. PDL can be sized best in LOVE sagittal views, whereas a synopsis of LOVE sagittal, axial and coronal views allows further examination and detection of small leaks. PDL are common after successful interventional LAAC, which can be accurately detected and sized by standardized cCTA imaging protocols.

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Acknowledgements

Supported by the DZHK (Deutsches Zentrum fur Herz-Kreislauf-Forschung - German Centre for Cardiovascular Research).

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Author notes

  1. Simon Lindner and Michael Behnes have contributed equally to this study.

Authors and Affiliations

  1. First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany

    Simon Lindner, Michael Behnes, Annika Wenke, Benjamin Sartorius, Uzair Ansari, Martin Borggrefe & Ibrahim Akin

  2. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

    Muharrem Akin

  3. Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Bad Krozingen, Germany

    Kambis Mashayekhi

  4. Institute of Clinical Radiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Nils Vogler, Holger Haubenreisser & Stefan O. Schoenberg

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  1. Simon Lindner
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  2. Michael Behnes
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  3. Annika Wenke
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Corresponding author

Correspondence to Michael Behnes.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has been approved by the medical ethics committee II of the Faculty of Medicine Mannheim, University of Heidelberg, Germany.

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Informed consent was obtained from all individual participants included in the study.

Research involving human and animal participants

This article does not contain any studies with animals performed by any of the authors.

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Lindner, S., Behnes, M., Wenke, A. et al. Assessment of peri-device leaks after interventional left atrial appendage closure using standardized imaging by cardiac computed tomography angiography. Int J Cardiovasc Imaging 35, 725–731 (2019). https://doi.org/10.1007/s10554-018-1493-z

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  • DOI: https://doi.org/10.1007/s10554-018-1493-z

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