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Cardiac CT and echocardiographic evaluation of peri-device flow after percutaneous left atrial appendage closure using the AMPLATZER cardiac plug device


Jaguszewski, Milosz; Manes, Costantina; Puippe, Gilbert; Salzberg, Sacha; Müller, Maja; Falk, Volkmar; Lüscher, Thomas; Luft, Andreas; Alkadhi, Hatem; Landmesser, Ulf (2015). Cardiac CT and echocardiographic evaluation of peri-device flow after percutaneous left atrial appendage closure using the AMPLATZER cardiac plug device. Catheterization and Cardiovascular Interventions, 85(2):306-312.

Abstract

Objectives: The aim of the study was to examine frequency, size and localization of peri-device leaks after percutaneous left atrial appendage(LAA)-closure with the AMPLATZER-Cardiac-Plug (ACP) by using a multimodal imaging approach, i.e. combined cardiac-CT and TEE follow-up. Background: Catheter-based LAA-occlusion using ACP aims to reduce the risk of stroke in patients with atrial fibrillation. Detection of peri-device leaks after ACP implantation by TEE is challenging, the few available data are inconsistent and the frequency of LAA leaks after ACP implantation remains therefore unclear. Methods: Cardiac-CT using a multi-phase protocol and a second-generation dual-source-CT-system was performed in twenty-four patients with non-valvular atrial fibrillation starting 3 months after LAA-closure by ACP. Color Doppler multiplane TEE was used to evaluate peri-device flow. Results: Cardiac-CT follow-up detected any persistent LAA contrast filling in 62% of patients (n=15), but leak-sizes were small (1.5±1.4mm). Peri-device leaks were almost exclusively localized at the posterior portion of the LAA-orifice (>90%). TEE follow-up revealed peri-device flow in 36% of patients (jet-sizes:≤4mm). ACP-lobe compression (>10 %) and perpendicular ACP-lobe orientation to the LAA-neck axis, that was also dependent on LAA anatomy, were substantially more frequent in patients with complete LAA closure. Conclusion: The present study evaluates for the first time peri-device flow after LAA closure by ACP using a combined cardiac-CT and TEE follow-up. Persistent LAA-perfusion was frequently detected, leak-sizes were small and were less frequent when lobe compression was >10% and lobe orientation was perpendicular to the LAA-neck axis, that was also related to the LAA anatomy. The clinical significance of these small leaks after LAA-closure using ACP needs to be further evaluated in future studies. © 2014 Wiley Periodicals, Inc.

Abstract

Objectives: The aim of the study was to examine frequency, size and localization of peri-device leaks after percutaneous left atrial appendage(LAA)-closure with the AMPLATZER-Cardiac-Plug (ACP) by using a multimodal imaging approach, i.e. combined cardiac-CT and TEE follow-up. Background: Catheter-based LAA-occlusion using ACP aims to reduce the risk of stroke in patients with atrial fibrillation. Detection of peri-device leaks after ACP implantation by TEE is challenging, the few available data are inconsistent and the frequency of LAA leaks after ACP implantation remains therefore unclear. Methods: Cardiac-CT using a multi-phase protocol and a second-generation dual-source-CT-system was performed in twenty-four patients with non-valvular atrial fibrillation starting 3 months after LAA-closure by ACP. Color Doppler multiplane TEE was used to evaluate peri-device flow. Results: Cardiac-CT follow-up detected any persistent LAA contrast filling in 62% of patients (n=15), but leak-sizes were small (1.5±1.4mm). Peri-device leaks were almost exclusively localized at the posterior portion of the LAA-orifice (>90%). TEE follow-up revealed peri-device flow in 36% of patients (jet-sizes:≤4mm). ACP-lobe compression (>10 %) and perpendicular ACP-lobe orientation to the LAA-neck axis, that was also dependent on LAA anatomy, were substantially more frequent in patients with complete LAA closure. Conclusion: The present study evaluates for the first time peri-device flow after LAA closure by ACP using a combined cardiac-CT and TEE follow-up. Persistent LAA-perfusion was frequently detected, leak-sizes were small and were less frequent when lobe compression was >10% and lobe orientation was perpendicular to the LAA-neck axis, that was also related to the LAA anatomy. The clinical significance of these small leaks after LAA-closure using ACP needs to be further evaluated in future studies. © 2014 Wiley Periodicals, Inc.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Date:2015
Deposited On:23 Sep 2014 12:37
Last Modified:05 Apr 2016 18:22
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1522-1946
Publisher DOI:https://doi.org/10.1002/ccd.25667
PubMed ID:25205611

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