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Updated: Aug 11, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The role of cardiac imaging before and after left atrial appendage standalone thoracoscopic exclusion
Marianna Mochen1, Stefano Branzoli2, Giovanni D'Onghia3
1Department of Radiology.
Insights
Totally thoracoscopic left atrial appendage (LAA) exclusion effectively prevents stroke in nonvalvular atrial fibrillation (NVAF) patients. Cardiac imaging accurately assesses LAA stump characteristics and left atrial volume post-procedure.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Procedures
Background:
- Nonvalvular atrial fibrillation (NVAF) poses a significant stroke risk.
- Oral anticoagulation (OAC) is standard but has contraindications.
- Left atrial appendage (LAA) exclusion is an alternative stroke prevention strategy.
Purpose of the Study:
- To evaluate LAA stump characteristics and left atrial (LA) volume after thoracoscopic LAA exclusion.
- To assess the efficacy of cardiac computed tomography (CCT) and transoesophageal echocardiography (TOE) in this evaluation.
- To determine the safety and effectiveness of standalone thoracoscopic LAA exclusion in NVAF patients unsuitable for OAC.
Main Methods:
- 40 NVAF patients with OAC contraindications underwent totally thoracoscopic LAA exclusion.
- CCT and TOE were used for pre- and post-procedural assessment at 3 months.
- LAA stump depth was measured using a novel method based on the left circumflex artery (LCX) course.
Main Results:
- Successful LAA exclusion in all 40 patients, with no strokes occurring.
- LAA stumps were observed in 18 patients (67% with depth <10 mm).
- Significant differences in LA volume were noted between patients with and without LAA stumps; CCT and TOE showed high correlation in stump assessment.
Conclusions:
- Standalone totally thoracoscopic LAA exclusion is effective and safe for NVAF patients with OAC contraindications.
- CCT and TOE are valuable, comparable tools for assessing LAA and LA anatomy pre- and post-procedure.
- Imaging can identify anatomical features associated with postprocedural LAA stumps.
Aims:
To assess the characteristics of left atrial appendage (LAA) stump and left atrial (LA) volume after standalone totally thoracoscopic LAA exclusion in 40 patients with nonvalvular atrial fibrillation (NVAF) and contraindications to oral anticoagulation (OAC), using cardiac computed tomography (CCT) and transoesophageal echocardiography (TOE).
Methods:
Using CCT and TOE, we evaluated correct AtriClip Pro II positioning, the presence and characteristics of the LAA stump and the postprocedural LA volume, at 3 months' follow-up. Stump depth was measured with both CCT and TOE using a new method, based on left circumflex artery (LCX) course.
Results:
After placement of AtriClip, all 40 patients discontinued OAC, and no stroke occurred. LAA exclusion was achieved in 40/40 patients at 3 months' follow-up. LAA stump (depth <10 mm in 12/18 stump, 67%) was observed in 18 patients. The overall (LA + LAA) volume and isolated LA volume were statistically different when comparing cases with and without LAA stump (P < 0.02). LAA ostium dimensions (perimeter and area) and LAA volume correlate with stump depth (P < 0.02). There was a high correlation between CCT and TOE in stump identification and depth measurement (P < 0.02). Compared with the baseline, CCT LA volume increased (P < 0.01) at 3 months' follow-up.
Conclusion:
Preprocedural and postprocedural CCT and TOE are useful and comparable in patients undergoing standalone totally thoracoscopic exclusion of LAA, because these imaging methods can identify anatomical LAA and LA characteristics predisposing for a postprocedural residual stump.
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