Usefulness of preprocedural 3-dimensional computed tomography planning in assisting one-stage pulmonary veins isolation with concomitant left atrial appendage occlusion procedure: A pilot study

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-02-01 DOI:10.1016/j.ijcha.2024.101594

Ke-Wei Chen , Yen-Nien Lin , Mei-Yao Wu , Yi-Hsiu Wu , Wen-Sheng Feng , Ping-Han Lo , Wei-Hsin Chung , Cheng-Chang Tung , Kuan-Cheng Chang

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引用次数: 0

Abstract

Background

The optimal imaging modality for selecting the device size in patients with atrial fibrillation undergoing one-stop left atrial appendage occlusion (LAAO) with concomitant pulmonary vein isolation (PVi) remains undefined. We compared preprocedural 3-dimensional computed tomography (3D CT) with intra-procedural transesophageal echocardiography (TEE) and left atrial appendage (LAA) angiography in guiding one-stage PVi and LAAO.

Methods

We measured the LAA ostium diameter using an interactive 3D CT system with a central line-based approach and compared these measurements with those from intra-procedural TEE and angiography, and the actual device size. The optimal compression ratio was used to assess the attainment rates of the three imaging modalities.

Results

Twenty-two patients (median age: 68.5 years, 21.8 % female) underwent the one-stage procedure. The median LAA ostium diameter measured by 3D CT (24.3 mm, interquartile range [IQR] = 22.0–27.0 mm) was closer to the Watchman device size (27.0 mm, IQR = 24.0–31.0 mm, P = 0.127) compared to TEE (21.2 mm, IQR = 18.4–22.7 mm, P < 0.001) and angiography (22.5 mm, IQR = 17.9–25.1 mm, P < 0.001). 3D CT had a better attainment rate for the optimal compression ratio than TEE (10.8 %, IQR = 7.4–16.5 % vs. 22.7 %, IQR = 19.2–29.3 %, P < 0.001) and angiography (19.7 %, IQR = 15.1–24.1 %, P = 0.001). All patients underwent successful device implantation without peri-device leak or complications during the periprocedural period and follow-up.

Conclusions

In this pilot study, a preprocedural central line-based 3D CT planning system appeared to be more effective than intraoperative TEE and angiography in measuring the LAA ostium diameter to guide device size selection in patients with atrial fibrillation undergoing one-stop LAAO with concomitant PVi.

Abstract Image

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术前三维计算机断层扫描计划在辅助一期肺静脉隔离合并左心耳闭塞术中的有效性：一项初步研究。

背景：心房颤动患者行一站式左房耳闭塞术（LAAO）合并肺静脉隔离术（PVi）时，选择装置尺寸的最佳成像方式尚不明确。我们比较了术前三维计算机断层扫描（3D CT）与术中经食管超声心动图（TEE）和左心耳血管造影（LAA）对一期PVi和LAAO的指导作用。方法：我们使用基于中心线的交互式3D CT系统测量LAA口直径，并将这些测量结果与术中TEE和血管造影的测量结果以及实际设备尺寸进行比较。使用最佳压缩比来评估三种成像方式的成功率。结果：22例患者（中位年龄：68.5岁，21.8%为女性）接受了一期手术。与TEE （21.2 mm, IQR = 18.4 ~ 22.7 mm, P < 0.001）和血管造影（22.5 mm, IQR = 17.9 ~ 25.1 mm, P < 0.001）相比，3D CT测量LAA中位口直径（24.3 mm，四分位间距[IQR] = 22.0 ~ 27.0 mm）更接近Watchman装置尺寸（27.0 mm, IQR = 24.0 ~ 31.0 mm, P = 0.127）。3D CT对最佳压缩比的满意率高于TEE （10.8%, IQR = 7.4 ~ 16.5% vs. 22.7%, IQR = 19.2 ~ 29.3%, P < 0.001）和血管造影（19.7%,IQR = 15.1 ~ 24.1%, P = 0.001）。所有患者在围手术期和随访期间均成功植入器械，无器械外漏或并发症。结论：在这项初步研究中，术前基于中心线的3D CT规划系统比术中TEE和血管造影更有效地测量LAA口直径，以指导房颤患者进行一站式LAAO合并PVi的设备尺寸选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.