Po-03-194 superiority of an interactive preprocedural computed tomography planning versus transesophageal echocardiography in assisting one-stop left atrial appendage occlusion with concomitant pulmonary veins isolation procedure

The relative value of using different imaging modalities in guiding selection of optimal device size in atrial fibrillation (AF) patients receiving one-stop procedure for left atrial appendage occlusion (LAAO) and pulmonary veins isolation (PVi) remains unknown. We aimed to compare the performance of preprocedural 3-dimensional computed tomography (3D CT) in assessing the diameter of LAA ostium with transesophageal echocardiography (TEE) imaging in guiding the one-stop LAAO with concomitant PVi procedure. The interactive preprocedural 3D CT system used a medial axis-assisted internal circumferential approach to determine the LAA ostium diameter. The contour of the LAA opening was judged by calculating the winding number of the contour lines around the centerline. We compared the LAA ostium diameter determined by 3D CT, TEE, and intraprocedural LA angiography against the actual device size. A manufacturer- suggested optimal compression ratio of 8% - 20% was used to assess the attainment rate among the three imaging modalities. Eleven consecutive patients with a mean age of 66.7±10.2 years old and 18.2% of female received one-stop procedure of LAAO with the Watchman device and PVi by radiofrequency ablation. The size of LAA ostium measured by 3D CT was closer to the final size of Watchman device (24.1±3.9 mm vs. 27.0±4.2 mm, P=0.919) compared with that assessed by TEE (21.3±3.5 mm, P=0.018) and LA angiography (21.7±4.0 mm, P=0.053). Preprocedural 3D CT measurement was associated with a better attainment rate in achieving the optimal compression ratio than that of TEE (10.7±5.8% vs. 20.8±6.5%, P=0.005) and LA angiography (10.7±5.8% vs. 19.8±7.4%, P=0.025). Successful device implantation was achieved in all enrolled patients, and none of patients had peri-device leak and other complications after device implantation. Preprocedural 3D CT planning to assess the LAA ostium diameter in guiding selection of device size was superior to TEE or intraoperative LA angiography in AF patients receiving one-stop procedure of LAAO with the Watchman device and PVi by radiofrequency ablation.