Related Experiment Video
Updated: May 5, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Geometry of left atrial appendage assessed with multidetector-row computed tomography: implications for transcatheter
Philippe J van Rosendael1, Spyridon Katsanos, Olivier W V van den Brink
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Multidetector-row computed tomography (MDCT) accurately assesses left atrial appendage (LAA) geometry. This imaging is highly feasible for guiding the selection of Watchman and Amplatzer Cardiac Plug (ACP) closure devices.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Left atrial appendage (LAA) closure is crucial for preventing stroke in atrial fibrillation.
- Accurate LAA geometry assessment is vital for successful device implantation.
- Multidetector-row computed tomography (MDCT) offers detailed anatomical visualization.
Purpose of the Study:
- To evaluate the utility of MDCT in characterizing LAA dimensions.
- To determine the feasibility of implanting Watchman and Amplatzer Cardiac Plug (ACP) devices based on MDCT measurements.
- To correlate LAA geometry with device selection for LAA closure procedures.
Main Methods:
- Retrospective analysis of 197 patients undergoing MDCT prior to atrial fibrillation catheter ablation.
- Assessment of LAA ostium and 10 mm depth diameters and perimeters using MDCT.
- Evaluation of LAA diameter on a transesophageal echocardiography (TEE)-like MDCT plane.
- Calculation of device feasibility based on measured LAA dimensions.
Main Results:
- High feasibility rates were observed for both Watchman (80.7%–93.9%) and ACP (84.8%–97%) devices based on MDCT measurements.
- Feasibility increased when considering both ostium and 10 mm depth measurements, and TEE-like views.
- Perimeter measurements indicated higher feasibility (up to 96.4%) compared to diameter measurements.
Conclusions:
- MDCT provides accurate LAA geometry assessment for LAA closure device selection.
- Current LAA closure devices demonstrate high feasibility rates based on MDCT imaging.
- MDCT measurements support the selection of appropriate LAA closure devices, with no significant difference between Watchman and ACP.
Aims:
To assess the left atrial appendage (LAA) geometry with multidetector-row computed tomography (MDCT) and its implications for selection of closure devices.
Methods And Results:
One hundred and ninety-seven patients who underwent MDCT prior to catheter ablation for atrial fibrillation were evaluated. Feasibility for Watchman and Amplatzer Cardiac Plug (ACP) devices was assessed based on the maximal cross-sectional diameter and perimeter of the ostium and at 10 mm depth and on the LAA diameter on the MDCT plane resembling the transoesophageal echocardiography (TEE) view. Mean maximal diameters of the ostium and at 10 mm depth were 28.7±4.4 mm and 24.6±4.5 mm, respectively, resulting in feasibilities of 80.7%, 84.8% and 91.4% for the Watchman, the ACP and for either one of the two devices, respectively. Mean perimeters of the ostium and at 10 mm depth were 79.1±12.2 mm and 69.8±11.6 mm, resulting in feasibilities of 87.8%, 92.9% and 96.4% for the Watchman, the ACP and for either one of the two devices, respectively. Mean TEE-like MDCT LAA diameter was 22.0±3.3 mm, resulting in feasibilities of 93.9%, 97% and 99.0% for the Watchman, the ACP and for either one of the two devices, respectively.
Conclusions:
The feasibility of current devices is high, based on MDCT measurements of the LAA, with no difference for either one of the devices.
