Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure

Left atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding structures, and pericardial effusion. Cardiac CT angiography (CCTA) is well suited to assess these non-invasively. We report our consecutive serie...

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Vydáno v:	European heart journal cardiovascular imaging Ročník 16; číslo 11; s. 1198
Hlavní autoři:	Saw, Jacqueline, Fahmy, Peter, DeJong, Peggy, Lempereur, Mathieu, Spencer, Ryan, Tsang, Michael, Gin, Kenneth, Jue, John, Mayo, John, McLaughlin, Patrick, Nicolaou, Savvas
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England 01.11.2015
Témata:	Aged Atrial Appendage - diagnostic imaging Atrial Appendage - surgery Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - surgery Cardiac-Gated Imaging Techniques Contrast Media Coronary Angiography Device Removal Endovascular Procedures Female Humans Male Postoperative Complications - diagnostic imaging Radiographic Image Interpretation, Computer-Assisted Septal Occluder Device Tomography, X-Ray Computed Treatment Outcome Triiodobenzoic Acids Amplatzer cardiac plug cardiac CTA Amulet left atrial appendage closure WATCHMAN
ISSN:	2047-2412, 2047-2412
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Abstract	Left atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding structures, and pericardial effusion. Cardiac CT angiography (CCTA) is well suited to assess these non-invasively. We report our consecutive series of non-valvular atrial fibrillation patients who underwent CCTA post-LAA closure with Amplatzer Cardiac Plug (ACP), Amulet (second generation ACP), or WATCHMAN devices. Patients underwent CCTA typically 1-6 months post-implantation. Prospective cardiac-gated CCTA was performed with Toshiba 320-detector or Siemens 2nd generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation™. GFR <30 mL/min/1.73 m(2) was an exclusion. We assessed for device thrombus, residual LAA leak, device embolization, position, pericardial effusion, optimal implantation, and device lobe dimensions. Forty-five patients underwent CCTA at median 97 days post-LAA closure (18 ACP, 9 Amulet, 18 WATCHMAN). Average age was 75.5 ± 8.9 years, mean CHADS2 score 3.1 ± 1.3, and CHADS-VASc score 4.9 ± 1.6. All had contraindications to oral anticoagulation. Post-procedure, 41 (91.1%) were discharged on DAPT. There was one device embolization (ACP, successfully retrieved percutaneously) and one thrombus (WATCHMAN, resolved with 3 months of warfarin). There were two pericardial effusions, both pre-existing and not requiring intervention. Residual leak (patency) was seen in 28/44 (63.6%), and the mechanisms of leak were readily identified by CCTA (off-axis device, gaps at orifice, or fabric leak). Mean follow-up was 1.2 ± 1.1year, with no death, stroke, or systemic embolism. CCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion.
AbstractList	Left atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding structures, and pericardial effusion. Cardiac CT angiography (CCTA) is well suited to assess these non-invasively. We report our consecutive series of non-valvular atrial fibrillation patients who underwent CCTA post-LAA closure with Amplatzer Cardiac Plug (ACP), Amulet (second generation ACP), or WATCHMAN devices. Patients underwent CCTA typically 1-6 months post-implantation. Prospective cardiac-gated CCTA was performed with Toshiba 320-detector or Siemens 2nd generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation™. GFR <30 mL/min/1.73 m(2) was an exclusion. We assessed for device thrombus, residual LAA leak, device embolization, position, pericardial effusion, optimal implantation, and device lobe dimensions. Forty-five patients underwent CCTA at median 97 days post-LAA closure (18 ACP, 9 Amulet, 18 WATCHMAN). Average age was 75.5 ± 8.9 years, mean CHADS2 score 3.1 ± 1.3, and CHADS-VASc score 4.9 ± 1.6. All had contraindications to oral anticoagulation. Post-procedure, 41 (91.1%) were discharged on DAPT. There was one device embolization (ACP, successfully retrieved percutaneously) and one thrombus (WATCHMAN, resolved with 3 months of warfarin). There were two pericardial effusions, both pre-existing and not requiring intervention. Residual leak (patency) was seen in 28/44 (63.6%), and the mechanisms of leak were readily identified by CCTA (off-axis device, gaps at orifice, or fabric leak). Mean follow-up was 1.2 ± 1.1year, with no death, stroke, or systemic embolism. CCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion. Left atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding structures, and pericardial effusion. Cardiac CT angiography (CCTA) is well suited to assess these non-invasively.AIMSLeft atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding structures, and pericardial effusion. Cardiac CT angiography (CCTA) is well suited to assess these non-invasively.We report our consecutive series of non-valvular atrial fibrillation patients who underwent CCTA post-LAA closure with Amplatzer Cardiac Plug (ACP), Amulet (second generation ACP), or WATCHMAN devices. Patients underwent CCTA typically 1-6 months post-implantation. Prospective cardiac-gated CCTA was performed with Toshiba 320-detector or Siemens 2nd generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation™. GFR <30 mL/min/1.73 m(2) was an exclusion. We assessed for device thrombus, residual LAA leak, device embolization, position, pericardial effusion, optimal implantation, and device lobe dimensions. Forty-five patients underwent CCTA at median 97 days post-LAA closure (18 ACP, 9 Amulet, 18 WATCHMAN). Average age was 75.5 ± 8.9 years, mean CHADS2 score 3.1 ± 1.3, and CHADS-VASc score 4.9 ± 1.6. All had contraindications to oral anticoagulation. Post-procedure, 41 (91.1%) were discharged on DAPT. There was one device embolization (ACP, successfully retrieved percutaneously) and one thrombus (WATCHMAN, resolved with 3 months of warfarin). There were two pericardial effusions, both pre-existing and not requiring intervention. Residual leak (patency) was seen in 28/44 (63.6%), and the mechanisms of leak were readily identified by CCTA (off-axis device, gaps at orifice, or fabric leak). Mean follow-up was 1.2 ± 1.1year, with no death, stroke, or systemic embolism.METHODS AND RESULTSWe report our consecutive series of non-valvular atrial fibrillation patients who underwent CCTA post-LAA closure with Amplatzer Cardiac Plug (ACP), Amulet (second generation ACP), or WATCHMAN devices. Patients underwent CCTA typically 1-6 months post-implantation. Prospective cardiac-gated CCTA was performed with Toshiba 320-detector or Siemens 2nd generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation™. GFR <30 mL/min/1.73 m(2) was an exclusion. We assessed for device thrombus, residual LAA leak, device embolization, position, pericardial effusion, optimal implantation, and device lobe dimensions. Forty-five patients underwent CCTA at median 97 days post-LAA closure (18 ACP, 9 Amulet, 18 WATCHMAN). Average age was 75.5 ± 8.9 years, mean CHADS2 score 3.1 ± 1.3, and CHADS-VASc score 4.9 ± 1.6. All had contraindications to oral anticoagulation. Post-procedure, 41 (91.1%) were discharged on DAPT. There was one device embolization (ACP, successfully retrieved percutaneously) and one thrombus (WATCHMAN, resolved with 3 months of warfarin). There were two pericardial effusions, both pre-existing and not requiring intervention. Residual leak (patency) was seen in 28/44 (63.6%), and the mechanisms of leak were readily identified by CCTA (off-axis device, gaps at orifice, or fabric leak). Mean follow-up was 1.2 ± 1.1year, with no death, stroke, or systemic embolism.CCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion.CONCLUSIONCCTA appears to be a feasible alternative to transoesophageal echocardiography for post-LAA device surveillance to evaluate for device thrombus, residual leak, embolization, position, and pericardial effusion.
Author	Tsang, Michael Gin, Kenneth Fahmy, Peter McLaughlin, Patrick Jue, John Mayo, John DeJong, Peggy Lempereur, Mathieu Spencer, Ryan Nicolaou, Savvas Saw, Jacqueline
Author_xml	– sequence: 1 givenname: Jacqueline surname: Saw fullname: Saw, Jacqueline email: jsaw@mail.ubc.ca organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 jsaw@mail.ubc.ca – sequence: 2 givenname: Peter surname: Fahmy fullname: Fahmy, Peter organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 3 givenname: Peggy surname: DeJong fullname: DeJong, Peggy organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 4 givenname: Mathieu surname: Lempereur fullname: Lempereur, Mathieu organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 5 givenname: Ryan surname: Spencer fullname: Spencer, Ryan organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 6 givenname: Michael surname: Tsang fullname: Tsang, Michael organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 7 givenname: Kenneth surname: Gin fullname: Gin, Kenneth organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 8 givenname: John surname: Jue fullname: Jue, John organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 9 givenname: John surname: Mayo fullname: Mayo, John organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 10 givenname: Patrick surname: McLaughlin fullname: McLaughlin, Patrick organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 – sequence: 11 givenname: Savvas surname: Nicolaou fullname: Nicolaou, Savvas organization: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9
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Copyright	Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
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Keywords	Amplatzer cardiac plug cardiac CTA Amulet left atrial appendage closure WATCHMAN
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Snippet	Left atrial appendage (LAA) device imaging after endovascular closure is important to assess for device thrombus, residual leak, positioning, surrounding...
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SubjectTerms	Aged Atrial Appendage - diagnostic imaging Atrial Appendage - surgery Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - surgery Cardiac-Gated Imaging Techniques Contrast Media Coronary Angiography Device Removal Endovascular Procedures Female Humans Male Postoperative Complications - diagnostic imaging Radiographic Image Interpretation, Computer-Assisted Septal Occluder Device Tomography, X-Ray Computed Treatment Outcome Triiodobenzoic Acids
Title	Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure
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