Preprocedural and Postprocedural CT Imaging Can Identify Patients at Risk for Complications After LAA Occlusion.

BACKGROUND

Left atrial appendage occlusion (LAAO) is an established alternative to long-term anticoagulation in patients with atrial fibrillation. Predicting successful LAAO device implantation with preplanning imaging studies, including cardiac computed tomography (CCT), remains a challenge.

OBJECTIVES

The purpose of this study was to determine whether specific preprocedural and postprocedural CCT measurements are associated with successful LAAO implantation and can predict early postimplant complications.

METHODS

This was a single-center retrospective study including 165 patients who underwent LAAO with Watchman FLX between November 2022 and January 2025 and had both preimplant and postimplant CCT. Adverse events including peri-device leak, device-related thrombus, or cerebrovascular events (transient ischemic attack/stroke) within 90 days were followed.

RESULTS

Adverse events occurred in 40 patients (24.2%), including 32 peri-device leaks, 9 device-related thrombi, and 1 transient ischemic attack. Those with events had significantly higher mean left atrial pressure (15.0 vs 13.5 mm Hg; P = 0.03), larger pre-CCT LAA ostium maximum diameter (26.6 vs 23.5; P < 0.001), larger pre-CCT minimum ostial diameter (21.8 vs 18.5 mm; P < 0.001), and smaller postimplant area change (66.5 vs 136.9 mm2; P < 0.001).

CONCLUSIONS

Smaller LAA ostial dimensions and greater device compression (postimplant area change) on CCT were associated with fewer complications post-LAAO. Favorable preimplant LAA ostial morphology seems to be oval shaped and of smaller size. These characteristics could be helpful in predicting better postimplant outcomes.