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Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT

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Abstract

Purpose

Recent development of percutaneous left atrial appendage (LAA) occlusion devices has underscored the need for an accurate understanding of LAA morphology and the interchangeability of results from differing imaging modalities. The purpose of this study is to assess LAA morphology and location in AF patients, directly comparing transesophageal echocardiography (TEE), planar cardiac computed tomography (CT), and three-dimensional segmented CT reconstructions.

Methods

Fifty-three patients underwent adequate TEE and cardiac CT. Quantitative measurements of maximal LAA orifice diameters, widths, and depths were obtained from each imaging modality. Left atrial and LAA volumes were measured using segmented CT.

Results

The mean LAA orifice diameter for segmented CT, planar CT, and TEE was 28.5 ± 4.5, 26.3 ± 4.1, and 26.1 ± 6.4 mm, respectively.

Conclusions

LAA orifice measurements among these imaging modalities are not interchangeable. This difference may be clinically significant because of the need for accurate sizing of LAA occlusion devices. Use of preprocedural segmented CT may improve initial device sizing.

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Abbreviations

AF:

atrial fibrillation

CI:

confidence interval

CT:

computed tomography

CTp:

planar computed tomography

CTsg:

three-dimensional segmented cardiac computed tomography

LA:

left atrium

LAA:

left atrial appendage

LIPV:

left inferior pulmonary vein

LSPV:

left superior pulmonary vein

SD:

standard deviation

TEE:

transesophageal echocardiography

3-D:

three-dimensional

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Correspondence to Loren P. Budge.

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Budge, L.P., Shaffer, K.M., Moorman, J.R. et al. Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT. J Interv Card Electrophysiol 23, 87–93 (2008). https://doi.org/10.1007/s10840-008-9281-7

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  • DOI: https://doi.org/10.1007/s10840-008-9281-7

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