Preprocedural and Postprocedural CT Imaging Can Identify Patients at Risk for Complications After LAA Occlusion

Left atrial appendage occlusion (LAAO) is an established alternative to long-term anticoagulation in patients with atrial fibrillation. Predicting successful LAAO device implantation with preplanning imaging studies, including cardiac computed tomography (CCT), remains a challenge.

The purpose of this study was to determine whether specific preprocedural and postprocedural CCT measurements are associated with successful LAAO implantation and can predict early postimplant complications.

This was a single-center retrospective study including 165 patients who underwent LAAO with Watchman FLX between November 2022 and January 2025 and had both preimplant and postimplant CCT. Adverse events including peri-device leak, device-related thrombus, or cerebrovascular events (transient ischemic attack/stroke) within 90 days were followed.

Adverse events occurred in 40 patients (24.2%), including 32 peri-device leaks, 9 device-related thrombi, and 1 transient ischemic attack. Those with events had significantly higher mean left atrial pressure (15.0 vs 13.5 mm Hg; P = 0.03), larger pre-CCT LAA ostium maximum diameter (26.6 vs 23.5; P < 0.001), larger pre-CCT minimum ostial diameter (21.8 vs 18.5 mm; P < 0.001), and smaller postimplant area change (66.5 vs 136.9 mm²; P < 0.001).

Smaller LAA ostial dimensions and greater device compression (postimplant area change) on CCT were associated with fewer complications post-LAAO. Favorable preimplant LAA ostial morphology seems to be oval shaped and of smaller size. These characteristics could be helpful in predicting better postimplant outcomes.