Comparison of Imaging Techniques to Assess Appendage Anatomy and Measurements of Left Atrial Appendage

Ehud Chorin 1 Yuval Levy 1 Sebastiano Gili 2 Matteo Anselmino 2 Martin Swaans 3 Galit Aviram 4 Dov Wexler 1 Simon Biner 1 Amir Halkin 1 Sami Viskin 1 Raphael Rosso 1
1Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv
2Life Sciences, Università degli Studi di Torino
3Cardiology, St. Antonius Hospital, Nieuwegein
4Radiology, Tel Aviv Sourasky Medical Center

Introduction: The implantation of a left atrial appendage (LAA) closure device requires adequate assessment of the left atrial appendage morphology and dimensions to ensure successful deployment of the occlusion device and to reduce the risk of perforation. Current protocols typically use transesophageal echocardiography (TEE) for evaluating LAA prior to implantation. The aim of this study was to compare TEE with multidetector computed tomography (MDCT) in the evaluation of LAA shape and dimensions.

Methods: This is a multi-center, retrospective study, including patients who underwent both TEE and MDCT prior to ablation of atrial fibrillation. All TEE studies were evaluated by three senior echocardiographists with experience in LAA occlusion and all MDCT studies were evaluated by two radiologists with experience in MDCT of the left atrium. The examiners were blinded to the results of each other. The following characteristics of LAA were compared: Number of lobes, type of LAA (cactus, chicken wing, windsock and cauliflower), LAA length, LAA orifice (oval-shaped or round-shaped), as well as diameter and area of the LAA orifice.

Results: 42 consecutive patients were studied. The overall interobserver agreement for TEE results by the echocardiographists were reported as follows: 1) Number of LAA lobes = 23% of cases; 2) type of LAA 6%, 3) LAA dimension (±10% of length) = 6% cases; 4) LAA orifice shape = 23% agreement; 5) LAA orifice diameter 15%. On the contrary, overall interobserver agreement for MDCT studies as evaluated by two radiologists was excellent.

Conclusion: LAA measurements are not well appreciated by TEE and TEE and MDCT are not interchangeable. Agreement between the two techniques in modest for some parameters and poor for others. This difference may be clinically significant because of the need for accurate sizing of LAA occlusion devices. Use of preprocedural MDCT may improve selection of the optimal device size.









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