Temporal Trends in Post-LAAO Surveillance Imaging: Increasing Adoption of CT-Based Follow-Up in Contemporary Practice

Abstract

Background

Surveillance imaging after left atrial appendage occlusion (LAAO) is recommended to evaluate for peri-device leak and device-related thrombus, with both transesophageal echocardiography (TEE) and cardiac computed tomography (CT) considered appropriate modalities. Longitudinal trends in surveillance imaging utilization and modality selection have not been well characterized in large, real-world populations.

Methods

We conducted a retrospective observational study using the TriNetX Research Network, a federated, de-identified electronic health record database. Adult patients (≥ 18 years) undergoing percutaneous transcatheter LAAO between January 2017 and December 2024 with available imaging data were included. Surveillance imaging was defined as TEE or cardiac CT performed between 45 and 365 days post-implantation. Annual rates of TEE-only, CT-only, and any surveillance imaging were calculated relative to total LAAO volume per year. Temporal trends were assessed using linear regression (p < 0.05).

Results

Among 33 267 patients, the proportion undergoing any surveillance imaging increased from 47.2% in 2017 to 66.6% in 2024 (slope +3.1%/year, p < 0.001). TEE utilization remained stable (slope +0.11%/year, p = 0.68), while CT utilization increased from 2.6% to 22.1% (slope +2.7%/year, p < 0.001). The overall increase in surveillance imaging was driven primarily by CT adoption. Approximately one-third of patients did not undergo any surveillance imaging within 1 year.

Conclusion

Between 2017 and 2024, CT utilization following LAAO increased nearly eightfold while TEE rates remained stable; however, approximately one-third of patients did not undergo any surveillance imaging within 1 year, revealing a substantial gap in adherence to FDA-mandated surveillance protocols.