Midterm follow‐up after computed tomography angiography planned left atrial appendage closure

Abstract

BackgroundWhile studies have shown the advantages of computed tomography angiography (CTA) over transesophageal echocardiography (TEE) in left atrial appendage closure (LAAC) preprocedural planning for WATCHMAN™ legacy and FLX devices, there has been no reported long‐term data for this approach.ObjectivesWe sought to evaluate long‐term outcomes using CTA‐based preprocedural planning for LAAC using the WATCHMAN™ device.MethodsA prospective analysis of 231 consecutive patients who underwent LAAC in a single, large academic hospital in the United States was conducted over a 5‐year period. CTA‐guided preprocedural planning was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. Rates of death, cerebral embolism, systemic embolism, and major and minor bleeding were recorded. Adjusted predicted stroke and major bleeding rates were derived from CHA2DS2‐Vasc and HAS‐BLED scores, respectively.ResultsFrom January 26, 2017, to November 23, 2021, 231 patients underwent LAAC with CTA preprocedural planning by two operating physicians. The mean age of patients was 76.5 ± 8.4. 59.7% of patients were male. Mean CHA2DS2VASc and HAS‐BLED scores were 4.5 ± 1.4 and 3.9 ± 0.9, respectively. All procedures were performed with intracardiac echo (100%). The procedural success rate was 99.1%. The CTA sizing strategy accurately predicted the implant size in 93.5% of patients. Mean number of devices used was 1.10 ± 0.3. Peri‐procedural complication rate was 2.2%. 6 patients were lost to follow‐up. Mean follow‐up was 608.94 days with a total of 377.04 patient years. Median follow‐up period of 368 days (interquartile range: 209–1067 days). There were 51 deaths from all causes (13.52 per 100 patient‐years), 10 cases of cerebral embolism (2.65 per 100 patient‐years), 2 cases of systemic embolism (0.53 per 100 patient‐years), 17 cases of major bleeding (4.50 per 100 patient‐years), and 31 cases of minor bleeding (8.2 per 100 patient‐years). All‐cause mortality at 1, 2, and 3 years was 12.7%, 20.9%, and 29.2%, respectively. CV event rates at 1, 2, and 3 years were 2.1%, 6.6%, and 10.5%, respectively.ConclusionsCTA‐based preprocedural planning is accurate in predicting device size for LAAC and associated with excellent clinical outcomes at 5 years.

Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device

“…Procedure planning is the key to minimize the risk of peri‐device leak or device‐related thrombosis. Recent studies suggested that CT‐guided procedure planning for the LAAC helped understanding of three‐dimensional LAA anatomy and provided accurate sizing of the LAA and higher procedural success as compared to TEE alone 2,3 …”

“…three-dimensional LAA anatomy and provided accurate sizing of the LAA and higher procedural success as compared to TEE alone. 2,3 On retrospective review of CT, the initial 24 mm Watchman device seemed too small for the LAA anatomy. Implantation of larger Watchman device in more proximal part of LAA would have resulted in complete sealing of LAA without peri-device leak.…”