Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Procedures

Background:

• Atrial fibrillation (AF) patients face stroke risks, with left atrial appendage (LAA) mechanical exclusion emerging as a non-pharmacologic strategy.
• Various LAA exclusion techniques are under development, each requiring specific patient anatomy for efficacy.

Purpose of the Study:

• To review imaging modalities and procedural approaches for LAA mechanical exclusion.
• To highlight the role of cardiovascular imaging in preprocedural planning and postprocedural assessment.

Main Methods:

• Review of imaging modalities including transesophageal echocardiography and cardiovascular computed tomographic angiography (CCTA).
• Discussion of diverse LAA exclusion methods: endovascular occlusion, epicardial ligation, thoracoscopic ligation/appendectomy, and surgical closure.
• Emphasis on imaging for assessing LAA size, anatomy, and potential obstacles.

Main Results:

• CCTA serves as a 'virtual patient avatar' for detailed preprocedural assessment of cardiac and surrounding anatomy.
• Transesophageal echocardiography is crucial for intraprocedural guidance.
• Successful LAA exclusion aims for complete appendage isolation, avoiding residual stumps or flow and protecting adjacent structures.

Conclusions:

• Cardiovascular imagers are vital for pre- and postprocedural evaluation of patients undergoing LAA exclusion.
• Accurate imaging facilitates optimal technique selection and procedural success in LAA mechanical exclusion.