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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Virtual reality utilization for left atrial appendage occluder device size prediction.

Shai Tejman-Yarden1,2,3, Dor Freidin2,3, Netanel Nagar2

  • 1The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel.

Heliyon
|April 24, 2023
PubMed
Summary

Virtual reality (VR) from cardiac CT angiography accurately predicts left atrial appendage occlusion device size. This novel imaging approach enhances pre-procedural evaluation for LAAO procedures.

Keywords:
Atrial fibrillationLeft atrial appendageVirtual reality

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Area of Science:

  • Cardiovascular Imaging
  • Medical Technology
  • Interventional Cardiology

Background:

  • Left atrial appendage occlusion (LAAO) is a key stroke prevention strategy in atrial fibrillation.
  • Accurate sizing of the LAA is crucial for successful LAAO device implantation.
  • Current imaging modalities have limitations in fully characterizing LAA anatomy.

Purpose of the Study:

  • To assess the feasibility and accuracy of virtual reality (VR) derived from cardiac computed tomography angiography (CCTA) for predicting LAAO device size.
  • To compare VR measurements with traditional CCTA and transesophageal echocardiography (TEE) measurements.
  • To evaluate the correlation between imaging measurements and the actual implanted device size.

Main Methods:

  • Retrospective analysis of 20 patients undergoing LAAO with pre-procedural CCTA.
  • Left atrial appendage (LAA) orifice diameters and perimeters measured using CCTA, VR, and TEE.
  • Comparison of measurements to the implanted LAAO device size using statistical analyses including Lin's Concordance Correlation Coefficient (ρ).

Main Results:

  • VR maximal diameter measurement showed the strongest correlation (ρ=0.78) with the implanted device size, outperforming CCTA (ρ=0.52) and TEE (ρ=0.60).
  • VR measurements demonstrated a smaller mean difference (-1.12 ± 2.3 mm) compared to CCTA (+0.92 ± 4.0 mm) and TEE (-3.45 ± 2.69 mm).
  • While VR perimeter correlation was moderate (ρ=0.54), its visualization aids in understanding complex LAA anatomy.

Conclusions:

  • Virtual reality derived from CCTA offers a feasible and accurate method for predicting LAAO device size.
  • VR provides superior correlation with implanted device diameter compared to CCTA and TEE.
  • VR imaging holds promise for improving pre-procedural evaluation of the LAA in LAAO procedures.