Value of Detecting Peri-Device Leak and Incomplete Endothelialization by
Cardiac CT Angiography in Atrial Fibrillation Patients Post Watchman
LAAC Combined with Radiofrequency Ablation
Abstract
OBJECTIVES: To explore the value of detecting the peri-device leak (PDL)
and device endothelialization after left atrial appendage closure (LAAC)
by cardiac CT in patients with atrial fibrillation (AF), who underwent
Watchman LAAC combined with radiofrequency ablation of atrial
fibrillation (AFCA) METHODS: Patients with symptomatic drug-refractory
atrial fibrillation at high risk of stroke (CHA2DS2-VASc Score ≥ 2), who
underwent Watchman LAAC combined with AFCA in our center from March 2017
to December 2018 were enrolled Maximum diameter of LAA orifice was
determined by preoperative CCTA A standardized view of Watchman device
was obtained by postoperative CCTA multi-plannar reconstruction to
evaluate the PDL and device endothelialization RESULTS: 84 patients post
successful LAAC and AFCA were enrolled in this study Satisfactory LAA
occlusion rate was 100% There were no death, bleeding, stroke, and
device related thrombus (DRT) events At 6-month post procedure, CCTA
images evidenced complete endothelialization in 44 patients (no contrast
enhancement in LAA); contrast enhancement in LAA and visible PDL in 33
patients; contrast enhancement in LAA but without PDL in 7 patients
(incomplete device endothelialization) Maximum diameter of LAA orifice
could independently predict the occurrence of PDL (OR, 1.31; 95% CI,
1.11-1.55; P = 0.002), sensitivity was 69.7% and specificity was 80.4%
with the cutoff value of maximum diameter of LAA orifice
>28.2 mm on predicting PDL CONCLUSIONS: CCTA is feasible to
evaluate PDL and device endothelialization after LAAC The maximum
diameter of LAA orifice derived from CT can independently predict the
occurrence of post-LAAC PDL