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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images

Pedro Morais, Sandro Queiros, Pieter De Meester

    IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control
    |October 4, 2018
    PubMed

    Insights

    A new semiautomatic technique accurately segments the left atrial appendage (LAA) in 3-D TEE images, improving device sizing for LAA occlusion procedures.

    Area of Science:

    • Medical Imaging
    • Cardiology
    • Computational Anatomy

    Background:

    • The left atrial appendage (LAA) is a primary source of thromboembolism in nonvalvular atrial fibrillation.
    • Left atrial appendage occlusion is a treatment option, but accurate device sizing is challenging.
    • Current manual image analysis for device sizing is time-consuming and variable.

    Purpose of the Study:

    • To develop and evaluate a semiautomatic segmentation technique for 3-D transesophageal echocardiography (TEE) images of the LAA.
    • To improve the accuracy and efficiency of LAA measurements for device selection in LAA occlusion procedures.

    Main Methods:

    • A novel semiautomatic LAA segmentation pipeline using a curvilinear blind-ended model and a double-stage optimization strategy.
    • Implementation within the B-spline explicit active surface framework to reduce computational cost.
    • Evaluation on a clinical database of 20 patients with manual analysis as ground truth.

    Main Results:

    • The proposed method achieved accurate LAA segmentation in approximately 14 seconds with an average accuracy of ~0.9 mm.
    • Segmentation results demonstrated robustness to parameter variations and computational attractiveness.
    • Semiautomatic extraction of clinical measurements showed high reproducibility compared to current practices.

    Conclusions:

    • The semiautomatic LAA segmentation technique offers accurate and efficient measurements for improved LAA occlusion planning.
    • The method shows potential to enhance clinical practice by reducing procedure time and variability.
    • This approach provides added value for device selection and procedural planning in LAA occlusion.

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