Position Statement on Cardiac Computed Tomography following Left Atrial Appendage Occlusion (JACC Cardiovascular Interventions August 2024)-Article: Position Statement on Cardiac Computed Tomography Following Left Atrial Appendage Occlusion

Article: Position Statement on Cardiac Computed Tomography Following Left Atrial Appendage Occlusion

Pdf Summary

Left atrial appendage occlusion (LAAO) is increasingly used for stroke prevention in atrial fibrillation (AF). Its efficacy and safety compared to traditional treatments are under investigation. Cardiac imaging, particularly cardiac computed tomography (CCT), has grown pivotal in planning and following up on LAAO procedures due to its non-invasive nature and high resolution.<br /><br />CCT is particularly advantageous in identifying complications such as peridevice leaks (PDL) and device-related thrombosis (DRT). However, its use post-LAAO is hindered by a lack of standardized protocols for acquiring and interpreting images. This review establishes a practical and standardized approach for CCT use after LAAO based on literature and expert consensus.<br /><br />Preprocedural scans usually combine CCT with 2D/3D transesophageal echocardiography (TEE), intracardiac echocardiography, or miniaturized TEE probes. Despite CCT’s advantages, including detailed evaluation without patient discomfort, its integration in postprocedural follow-up is not uniformly standardized.<br /><br />Post-LAAO, patients generally do not need sedation or fasting before CCT scans. Patient preparation is crucial to avoid motion artifacts and ensure high-quality imaging. The paper recommends technical protocols for imaging acquisition that shift from preprocedural to postprocedural needs, emphasizing the importance of high-performance CT scanners.<br /><br />Postprocedural evaluations focus on factors like device position and alignment, detection of DRT/HAT (hypoattenuated thickening), and PDL. Residual leaks are evaluated using CCT by measuring contrast medium density distal to the device and identifying visible PDLs. The method for DRT detection involves assessing HAT on the device surface, distinguishing between potential thrombus and healing processes.<br /><br />For managing detected issues, the document provides guidelines on patient management, emphasizing balancing the risk of thromboembolism and bleeding. It also discusses scenarios warranting thorough CCT evaluation, such as ischemic stroke or suspected device interference with anatomical structures.<br /><br />Future directions include leveraging CCT advances, like photon counting detectors, to improve spatial resolution and reduce radiation exposure, enhancing LAAO planning and follow-up. The consensus highlights the necessity of standardized CCT protocols to ensure optimal patient outcomes and facilitate further research.

Keywords

Left Atrial Appendage Occlusion

Stroke Prevention

Atrial Fibrillation

Cardiac Computed Tomography

Peridevice Leaks

Device-Related Thrombosis

Standardized Protocols

Patient Management

Thromboembolism

Photon Counting Detectors