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Original research article
A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure
  1. Danny HF Chow,
  2. Gintautas Bieliauskas,
  3. Fadi J Sawaya,
  4. Oscar Millan-Iturbe,
  5. Klaus F Kofoed,
  6. Lars Søndergaard and
  7. Ole De Backer
  1. The Heart Center Rigshospitalet University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Danny HF Chow; danny.chow.hf{at}


Objectives Accurate sizing of the left atrial appendage (LAA) is essential when performing percutaneous LAA closure. This study aimed to compare different LAA imaging modalities and sizing methods in order to obtain successful LAA closure.

Background Percutaneous LAA closure is an increasingly used treatment strategy to prevent stroke in patients with atrial fibrillation. LAA sizing has typically been done by 2D-transoesophageal echocardiography (TEE).

Methods Patients who had a preprocedural TEE and preprocedural and postprocedural multislice CT (MSCT) were identified. Preprocedural measurements of LAA ostia and landing zones by 2D-TEE, MSCT and angiography were collected and analysed for those patients with successful LAA closure - i.e. with no contrast leakage at 3-month follow-up MSCT.

Results The study population (n=67) had a mean CHA2DS2-VASc score of 3.0 and HAS-BLED score of 2.7. Fifty-eight patients (87%) were identified to have successful LAA closure. Based on MSCT, 48 LAA sizings (83%) resulted in a correct LAA closure device size selection, whereas with 2D-TEE sizing, only 33 measurements (57%) would have resulted in a correct device size selection (p<0.01). Using adapted Bland-Altman method, MSCT-based perimeter-derived mean diameter was shown to be the best parameter to guide LAA device size selection for ‘closed-end’ devices (Amulet, WatchmanFLX), whereas the maximal diameter was the best parameter for the ‘open-end’ Watchman device.

Conclusions Preprocedural MSCT-based LAA closure device size selection proves to be a more accurate method than conventional 2D-TEE-based sizing. Depending on the LAA closure device design, perimeter-derived mean diameter or maximal diameter could be the better sizing method.


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  • Contributors DHFC, ODB: study concept and design, drafting of manuscript,statistical analysis. DHFC, ODB, OMI, FJS: acquisition, analysis or interpretation of data. ODB, FJS, GB, KFK, LS: critical revision of manuscript. ODB: study supervision.

  • Competing interests None declared.

  • Patient consent Patient signed consent for this retrospective trial in danish.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Based on unique data provided by systematic preprocedural and postprocedural multislice CT (MSCT) imaging, this study indicates that preprocedural MSCT-based left atrial appendage (LAA) closure device size selection is more accurate than conventional 2D-transoesophageal echocardiography-based sizing. In addition, this study encompasses three different types of LAA closure devices and shows that, depending on the LAA device design, perimeter-derived mean diameter or maximal diameter could be the better sizing method. In conclusion, these data will be of high importance for the field of percutaneous LAA closure and will help to obtain even better procedural and clinical outcomes in the future.

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