Pre- and postoperative left atrial appendage visualization: selecting the optimal method

Background: Atrial fibrillation (AF) is reported to be one of the main etiological factors of ischemic stroke. Transcatheter occlusion of the left atrial appendage (LAAO) is an alternative to anticoagulant therapy in the thromboembolism prevention in atrial fibrillation patients with a high bleeding risk. The role of contrast-enhanced cardiac computed tomography (CT) for preoperative assessment and postoperative control has not been sufficiently studied to the present moment.

Objective: Comparison of the possibilities of transesophageal echocardiography (TEE) and computed tomography in pre- and postoperative imaging in the context of LAAO interventions.

Material and methods: This retrospective cohort study included 38 patients divided into 2 groups: in the first group TEE was used for intervention planning and postoperative control, patients of the second group were examined with CT. The indicators obtained during LAA measurements were assessed, as well as the result of the intervention – according to the risk of peripheral leakage into the left atrial appendage.

Results: The average left atrial appendage depth and orifice diameter according to transesophageal echocardiography were significantly smaller compared to computed tomography data (25.58 ± 4.65 versus 31.05 ± 6.41, p = 0.011; 17.21 ± 2.70 versus 18.55 ± 3.05 p = 0,006, respectively). In the computed tomography group, there was a not statistically significant trend towards a lower risk of leakage for 4–5 mm leaks (RR = 0.500; 95% CI 0.060–3.710) and for 2–3 mm leaks (RR = 0.500; 95% CI 0.150–1.540). In addition, 45 days after the intervention computed tomography revealed 5 cases of incomplete endothelialization of the device with the contrast agent leak into the LAA in the absence of peripheral leakage.

Conclusion: Contrast-enhanced cardiac computed tomography, unlike transesophageal echocardiography, allows to detect incomplete occlusive device endothelialization, which may influence the choice of postoperative antithrombotic therapy. The use of computed tomography in an intervention planning for the LAAO may reduce the risk of peripheral leakage, however, this hypothesis needs to be confirmed in studies with a larger number of patients.

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