Related Experiment Video
Updated: Oct 17, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion Using Cardiac CT Angiography and Intracardiac Echocardiography: A Prospective,
Steven J Filby1, Luis Augusto Palma Dallan, Anthony Cochet
1University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH 44106 USA. Steven.Filby@UHhospitals.org.
Insights
Cardiac computed tomography angiography (CTA) accurately guided device selection for percutaneous left atrial appendage occlusion (LAAO). This imaging approach, combined with intracardiac echocardiography (ICE), facilitated successful LAAO procedures with favorable outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Percutaneous left atrial appendage occlusion (LAAO) using the Watchman device is FDA-approved for stroke prevention in non-valvular atrial fibrillation patients contraindicated for anticoagulation.
- Preprocedural cardiac computed tomography angiography (CTA) planning and intracardiac echocardiography (ICE)-guided deployment may improve LAAO outcomes.
Purpose of the Study:
- To evaluate periprocedural events, device selection accuracy, and outcomes of LAAO procedures.
- To assess the efficacy of cardiac CTA-guided preprocedural planning and ICE-guided deployment.
Main Methods:
- A prospective analysis of 71 patients undergoing LAAO over 18 months at a single academic hospital.
- Procedures utilized cardiac CTA for preprocedural planning and ICE for device deployment.
- Evaluated procedural success, CTA sizing accuracy, adverse events, procedure length, and length of stay.
Main Results:
- Cardiac CTA preprocedural device sizing correlated with final device size in 97.2% of patients.
- Achieved a 100% procedural success rate with Watchman devices (2.5 and FLX platforms).
- Reported only 2 adverse events, both resolved; mean length of stay was 1.45 days.
Conclusions:
- Cardiac CTA-guided preprocedural planning ensures accurate device sizing for LAAO.
- Combining CTA planning with ICE and conscious sedation may enable same-day discharge for select LAAO patients.
Objectives:
We reviewed the periprocedural events, accuracy of device selection, and outcomes of a series of patients receiving percutaneous left atrial appendage occlusion (LAAO) with cardiac computed tomography angiography (CTA)-guided preprocedural planning and intracardiac echocardiography (ICE)-guided device deployment.
Background:
Percutaneous LAAO with the Watchman device (Boston Scientific) is approved by the United States Food and Drug Administration for stroke prevention in patients with non-valvular atrial fibrillation with a demonstrated contraindication to oral anticoagulation. Cardiac CTA preprocedural planning with utilization of an ICE-guided deployment may be associated with favorable outcomes.
Methods:
A prospective analysis of 71 non-consecutive patients who underwent LAAO over an 18-month period with cardiac CTA-guided preprocedural planning and ICE was conducted. Procedures were performed in a single large, academic hospital in the United States. Procedural success, correlation of CTA preprocedural device sizing with final device size utilization, adverse events, length of procedure, and length of stay were evaluated.
Results:
Preprocedural cardiac CTA-guided device sizing was consistent with the final deployed device in 69 patients (97.2%) evaluated in this case series. Procedure success rate was 100%. All implants were performed using Watchman devices, 45 (63.4%) with the original 2.5 platform and 26 (36.6%) with the Watchman FLX platform. All patients were treated with conscious sedation and the mean length of stay was 1.45 ± 0.72 days. Only 2 adverse events occurred and both resolved.
Conclusions:
Cardiac CTA-guided preprocedural planning resulted in accurate device sizing in this patient sample and may be used in conjunction with ICE and conscious sedation for a same-day discharge strategy in select patients.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:24Cardiac Catheterization III: Left Heart Catheterization