Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device.
Publication/Presentation Date
1-1-2018
Abstract
INTRODUCTION: Percutaneous left atrial appendage (LAA) occlusion is an emerging treatment option for patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation. The Watchman device (Boston Scientific Corporation, Natick, MA, USA) is deployed at the ostium of the LAA, and an appropriately sized device is critical for successful occlusion. However, standardized imaging protocols for device sizing have not been established.
OBJECTIVES: We investigated the clinical utility of a standardized imaging protocol, with pre-procedural multi-detector cardiac computed tomography (MDCT), and intra-procedural transesophageal echocardiography (TEE), for Watchman device sizing.
METHODS: Patients who underwent Watchman device implantation between 2010 and 2016 at our center, and who had pre-procedural MDCT and intra-procedural TEE were included. MDCT measurements (CTmax, CTmin, CTmean), and TEE measurement (TEEmax) of the LAA ostium were determined for each case, and correlated with the final size of the Watchman device implanted. Demographic data and clinical outcomes were collected.
RESULTS: The study included 80 patients (mean age: 75 ± 9.6 years; male: 68%; mean CHA2DS2-VASc score: 4.5 ± 1.4). CTmax of the LAA ostium correlated strongly with the final deployed Watchman device size (Spearman's rho: 0.81, p < 0.001), while TEEmax of the LAA ostium showed only moderate correlation with the final deployed Watchman device size (Spearman's rho: 0.61, p < 0.001). Implantation success rate was 100%. At a mean duration of follow-up of 197 days, there were no device-related complications (device embolization, cardiac perforation and pericardial tamponade). At follow-up, the vast majority of patients (76 patients; 95%) had either no or trivial (≤3 mm) residual peri-device leak on TEE.
CONCLUSIONS: A standardized imaging protocol for assessment of Watchman device implantation incorporating pre-procedural MDCT and intra-procedural TEE, was associated with excellent procedural outcomes at a mean duration of follow-up of 197 days.
Volume
12
Issue
1
First Page
50
Last Page
55
ISSN
1876-861X
Published In/Presented At
Xu, B., Betancor, J., Sato, K., Harb, S., Abdur Rehman, K., Patel, K., Kumar, A., Cremer, P. C., Jaber, W., Rodriguez, L. L., Schoenhagen, P., & Wazni, O. (2018). Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device. Journal of cardiovascular computed tomography, 12(1), 50–55. https://doi.org/10.1016/j.jcct.2017.11.012
Disciplines
Medicine and Health Sciences
PubMedID
29223726
Department(s)
Department of Medicine
Document Type
Article