Impact of Preprocedure Imaging for Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry

• Published in: JACC. Cardiovascular interventions Vol. 16; no. 11; pp. 1317 - 1328
• Main Authors: Clarke, John-Ross D, Higgins, Angela Y, Wang, Yongfei, Faridi, Kamil F, Curtis, Jeptha A, Freeman, James V, Friedman, Daniel J
• Format: Journal Article
• Language: English
• Published: United States 12-06-2023
• Subjects: Atrial Appendage - diagnostic imaging; Humans; Hypertension; Registries; Tomography, X-Ray Computed; Treatment Outcome; computed tomography; atrial fibrillation; left atrial appendage occlusion; magnetic resonance imaging
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2023.05.008

The impact of preprocedure imaging on the safety and effectiveness of left atrial appendage occlusion (LAAO) remains unclear.
This study sought to determine the rates of use of preprocedure computed tomography (CT)/cardiac magnetic resonance (CMR) and its association with safety and effectiveness of LAAO procedures.
The National Cardiovascular Data Registry LAAO Registry was used to evaluate patients who underwent attempted LAAO with the WATCHMAN and WATCHMAN FLX devices between January 1, 2016, and June 30, 2021. Safety and effectiveness of LAAO procedures was compared by use vs nonuse of preprocedural CT/CMR. Outcomes of interest included implantation success (deployment and release of device), device success (device released with peridevice leak <5 mm), and procedure success (device released with peridevice leak <5 mm and no in-hospital major adverse events [MAE]). Multivariable logistic regression was used to assess the relationship between preprocedure imaging and outcomes.
Preprocedure CT/CMR was used for 18.2% (n = 20,851) of the 114,384 procedures in this study. CT/CMR use was more common among government and university hospitals and hospitals in the Midwest and South; it was less common among patients with uncontrolled hypertension, with abnormal renal function, and without prior thromboembolism. Overall rates of implantation success, device success, and procedure success were 93.4%, 91.2%, and 89.4%, respectively. Preprocedure CT/CMR was independently associated with an increased likelihood of implantation success (OR: 1.08; 95% CI: 1.00-1.17), device success (OR: 1.10; 95% CI: 1.04-1.16), and procedural success (OR: 1.07; 95% CI: 1.02-1.13). MAE were uncommon (2.3%) and not associated with use of preprocedure CT/CMR (OR: 1.02; 95% CI: 0.92-1.12).
Preprocedure CT/CMR was associated with an increased likelihood of successful LAAO implantation; however, the magnitude of benefit appears small and it was not associated with MAE.