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Updated: Nov 19, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Application of cardiac computed tomographic imaging and fluoroscopy fusion for guiding left atrial appendage
1Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China.
Insights
Integrating 3D CT with fluoroscopy for WATCHMAN procedures significantly shortens procedure time and reduces radiation exposure and contrast media use. This fusion imaging approach is safe and effective for left atrial appendage occlusion (LAAO).
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Procedural guidance for LAAO traditionally relies on fluoroscopy, which involves radiation exposure and can be limited by visualization.
- 3D computed tomography (CT) offers detailed anatomical information but requires integration with real-time imaging for procedural application.
Purpose of the Study:
- To evaluate the efficacy and safety of integrating 3D CT with fluoroscopy for procedural guidance during WATCHMAN implantation.
- To compare clinical and procedural parameters between LAAO procedures performed with and without fusion imaging.
Main Methods:
- An observational study comparing LAAO with and without fusion imaging (GE Healthcare Advanced Workstation 4.6).
- Forty-one matched pairs of patients were enrolled.
- 3D cardiac anatomy and safe zones were identified using CT, with outlines projected onto real-time fluoroscopy for guidance.
Main Results:
- Fusion imaging significantly reduced procedural time (44.7 vs. 63.7 min, P < 0.001).
- Total radiation dose and dose area product were significantly lower with fusion imaging (448.8 vs. 798.4 mGy, P = 0.004; 38.0 vs. 67.7 Gy·cm², P = 0.004).
- Contrast volume was also significantly reduced (67.3 vs. 91.0 ml, P = 0.0004); short-term follow-up showed similar safety outcomes.
Conclusions:
- Automated real-time integration of cardiac CT and fluoroscopy is feasible, safe, and effective for LAAO.
- This image fusion technique significantly reduces radiation exposure, procedure duration, and contrast media volume.
- The potential of merging 3D CT reconstructions with real-time angiography in LAAO should be further explored.
Objective:
Evaluate the value of 3D computed tomography (CT) and CT-integrating fluoroscopy for procedural guidance during WATCHMAN implantation.
Methods:
This observational study compared the clinical and procedural parameters for LAAO with and without fusion imaging. Forty-one pairs of patients-matched by procedure month and with or without the use of the image fusion system-were enrolled. Using the image fusion Advanced Workstation 4.6 software (GE Healthcare), we identified the 3D cardiac anatomy and safe zones for septal punch. The LAA orifice anatomy outlines were then projected onto the real-time fluoroscopy image during the procedure to guide all the steps of LAAO.
Results:
The use of image fusion significantly reduced the procedural time, compared to the time required for the control group (44.73 ± 20.03 min vs. 63.73 ± 26.10 min, respectively; P < 0.001). When compared to the standard procedure, the use of image fusion significantly reduced both the total radiation dose (448.80 ± 556.35 mGy vs. 798.42 ± 616.34 mGy; P = 0.004) and dose area product (DAP) (38.03 ± 47.15 Gy∙cm2 vs. 67.66 ± 52.23 Gy∙cm2, P = 0.004). Corresponding to the radiation dose, the contrast volume was also reduced (67.32 ± 18.65 vs. 90.98 ± 25.03 ml; P = 0.0004). During short-term follow-up at 6 months, there was only one femoral hematoma and incomplete LAA sealing (>3 mm) in either group.
Conclusions:
Automated real-time integration of cardiac CT and fluoroscopy is feasible, safe, and applicable in LAAO. It may significantly reduce the radiation exposure, procedure duration, and volume of contrast media. Following these results, the potential of merging reconstructed 3D CT scans with real-time coronary angiography should be fully exploited in LAAO.
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