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Updated: Oct 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac
Iksung Cho1, William D Kim1, Oh Hyun Lee2
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Insights
Cardiac computed tomography (CT) offers precise left atrial appendage (LAA) anatomy evaluation. Perimeter-derived diameter from CT images most accurately predicts LAA occlusion device size, regardless of LAA shape.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Two-dimensional transesophageal echocardiography has limitations in predicting left atrial appendage occlusion (LAAO) device size due to complex LAA anatomy.
- Three-dimensional cardiac computed tomography (CT) provides more precise LAA anatomical evaluation.
- Optimal CT-derived parameter for pre-procedural LAAO device selection remains unclear.
Purpose of the Study:
- To assess the accuracy of various measurements derived from cardiac CT images for selecting appropriate LAAO devices.
- To compare the predictive accuracy of different CT-derived LAA landing zone diameters (minimal, maximal, average, area-derived, perimeter-derived) against actual implanted device sizes.
Main Methods:
- Retrospective review of 62 patients who underwent LAAO device implantation (Amplatzer Cardiac Plug and Amulet) between 2017 and 2020.
- Measurement of LAA landing zone diameters (minimal, maximal, average, area-derived, perimeter-derived) using pre-procedural cardiac CT images.
- Comparison of predicted device sizes based on CT measurements with the actual successfully implanted device sizes.
Main Results:
- The perimeter-derived diameter demonstrated the most accurate prediction of LAAO device size (mean error = -0.8 ± 2.4 mm).
- Other measured diameters (minimal, maximal, average, area-derived) showed significantly larger prediction errors.
- The perimeter-derived diameter maintained accuracy across varying degrees of landing zone eccentricity, unlike other parameters.
Conclusions:
- Perimeter-derived diameter from cardiac CT imaging is the most accurate parameter for predicting LAAO device size.
- Cardiac CT-based perimeter measurement eliminates the need for oversizing and accurately guides device selection, irrespective of LAA landing zone shape.
- This finding can improve the success rate and safety of LAA occlusion procedures.
Abstract:
The complex structure of the left atrial appendage (LAA) brings limitations to the two-dimensional-based LAA occlusion (LAAO) size prediction system using transesophageal echocardiography. The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac computed tomography (CT); however, there is lack of data regarding which parameter to choose from CT-based images during pre-procedural planning of LAAO. We aimed to assess the accuracy of measurements derived from cardiac CT images for selecting LAAO devices. We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes. The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = - 0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = - 4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = - 1.6 ± 2.6 mm, area-derived diameter = - 2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference < 0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement. The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.
