Comparison of multiple imaging modalities for measuring orifice diameter and selecting occluder size in patients...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Left atrial appendage (LAA) closure (LAAC) is a stroke prevention strategy for atrial fibrillation patients.
• Individual LAA anatomy varies significantly, necessitating precise measurement for effective device selection.
• Optimal imaging methods for LAA measurement remain undetermined.

Purpose of the Study:

• To evaluate the accuracy of computed tomography angiography (CTA), 3D reconstruction from CTA, 2D transesophageal echocardiography (2D-TEE), and digital subtraction angiography (DSA) for LAA diameter measurement.
• To compare the efficacy of these imaging modalities in guiding occluder size selection for LAAC.

Main Methods:

• Retrospective analysis of 148 nonvalvular atrial fibrillation patients undergoing LAAC.
• Pre-procedural CTA and 2D-TEE were performed; 3D reconstructions of the LAA were generated using Mimics and 3-matics software.
• Intraoperative DSA of the LAA was conducted.

Main Results:

• CTA 3D reconstruction yielded significantly larger LAA diameter measurements compared to other methods.
• DSA measurements were significantly lower than CTA and CTA 3D reconstruction values.
• Occluder size showed a positive correlation with LAA orifice diameter; CTA 3D reconstruction demonstrated the highest intraclass correlation coefficient (.519) and smallest difference (2.92 ± 1.38 mm) with occluder size.

Conclusions:

• CTA 3D reconstruction provides superior correlation and consistency for LAA orifice diameter measurement relative to occluder size.
• Adding 2-4 mm to the maximum LAA orifice diameter measured by 3D-CTA may optimize WATCHMAN device selection.
• 3D-CTA reconstruction is recommended for accurate LAA assessment in LAAC procedures.