A Comparative Study of Three Imaging Modalities for Size Selection of a Watchman Left Atrial Appendage Closure Device

Area of Science:

• Cardiovascular imaging
• Interventional cardiology
• Medical device assessment

Background:

• Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation (AF).
• Accurate measurement of the left atrial appendage (LAA) dimensions is crucial for successful device implantation.
• Comparing different imaging modalities for pre-procedural assessment is essential.

Purpose of the Study:

• To compare measurements of LAA diameter and depth using computed tomography angiography (CTA), transesophageal echocardiography (TEE), and digital subtraction angiography (DSA).
• To analyze the accuracy, correlation, and consistency of these imaging modalities with Watchman device size in patients who underwent LAAC.

Main Methods:

• A study included 157 patients with non-valvular AF who underwent successful LAAC with Watchman devices.
• LAA maximum diameter and depth were measured using CTA, TEE, and DSA.
• Correlations and agreement between imaging measurements and Watchman device size were analyzed.

Main Results:

• All LAAC procedures with Watchman devices were successful.
• CTA measurements for LAA ostium diameter were significantly larger than DSA and TEE.
• Good correlations were observed between all imaging modalities and Watchman device size; DSA showed the widest limits of agreement.

Conclusions:

• CTA, TEE, and DSA demonstrate good correlation with Watchman device size for LAAC.
• CTA tends to overestimate LAA dimensions compared to TEE and DSA.
• DSA measurements provided the widest agreement with the actual device size used.