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Published on: February 26, 2013
Feasibility of Left Atrial Appendage Occlusion Without Preprocedural Transesophageal Echocardiography or CT Scanning
Daniel Hammersley, Steven Podd, Ari Gomes
1Royal Sussex Cardiac Centre, Brighton Department of Cardiology, Brighton, BN2 5BE, United Kingdom. david.hildick-smith@bsuh.nhs.uk.
Insights
Left atrial appendage occlusion (LAAO) is successful in 98.1% of patients without preprocedural imaging. Omitting this imaging reduces risks, costs, and patient discomfort without impacting procedural success.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Left atrial appendage occlusion (LAAO) typically requires preprocedural imaging (TEE or CT).
- The necessity of this routine preprocedural imaging in LAAO is questioned.
Purpose of the Study:
- To evaluate the success rate and safety of LAAO procedures performed without preprocedural imaging.
- To determine if omitting preprocedural imaging affects LAAO outcomes.
Main Methods:
- A cohort of 52 patients underwent LAAO without preprocedural imaging.
- Procedural success and major complication rates were assessed.
Main Results:
- LAAO was successful in 98.1% (51/52) of patients.
- Major complications occurred in 3.8% (2/52) of patients, primarily vascular injuries.
- No left atrial appendage thrombus was detected despite low oral anticoagulation use.
Conclusions:
- Left atrial appendage occlusion can be performed successfully without preprocedural imaging.
- Omitting preprocedural imaging reduces risks, costs, and patient burden.
- Further large-scale studies are recommended to confirm these findings.
Objective:
To assess the success rate and safety outcomes of left atrial appendage occlusion (LAAO) procedures in a cohort of patients who had not undergone preprocedural imaging.
Background:
LAAO patients usually undergo imaging with either transesophageal echocardiography (TEE) or computed tomography (CT) prior to the procedure itself. This preprocedural imaging may not be necessary.
Methods:
The procedural success and major complication rates were assessed in a cohort of 52 patients who underwent LAAO without preprocedural imaging.
Results:
Mean patient age was 75 ± 8 years. Median CHA2DS2-VASc score was 4 and median HASBLED score was 3. The LAAO procedure was successful in 51/52 cases (98.1%). In 1 case, the LAAO procedure did not proceed because the LAA was too large for the available occlusion devices. No patient had left atrial appendage thrombus, despite the fact that only 4 patients were taking oral anticoagulation therapy at the time. Major complications occurred in 2/52 cases (3.8%), both due to vascular injuries causing pseudoaneurysm formation.
Conclusion:
LAAO in this series was not adversely affected by lack of preprocedural imaging. Omitting preprocedural imaging reduces risk attributable to the modality, reduces patient inconvenience and discomfort, reduces cost, and does not appear to significantly reduce the proportion of patients who can undergo a successful procedure. Further larger studies are warranted.
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