Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-220 - Procedural Planning Using Computed Tomography Versus Transesophageal Echocardiography For Percutaneous Left Atrial Appendage Occlusion And Associated Clinical Outcomes: A Meta-analysis (ID 1066)

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) is rapidly gaining clinical use. Accurate pre-procedural evaluation of the LAA is critical for appropriate device size selection and successful device implantation. Transesophageal echocardiography (TEE) is currently the standard practice, and the role of computed tomography (CT) in this setting is largely unknown.
Objective: To compare the use of CT versus TEE for procedural planning prior to percutaneous LAA occlusion.
Methods: A systematic review of MEDLINE, Cochrane Library, and Embase for studies that used CT and TEE for procedural planning for percutaneous LAAO. Relative risk (RR) and 95% confidence interval (CI) for incorrect device size selection by CT versus TEE were determined. Procedural outcomes (procedure time, Air Kerma, and contrast volume) were compared using mean differences. Fixed effects model was used and random effects model was used when heterogeneity (I2) was >25%.
Results: The risk of incorrect device size selection was significantly less with pre-procedural CT compared to TEE (Included seven studies [343 patients]; overall RR 0.34; 95% CI 0.19-0.59). Pre-procedural CT was associated with improvements in procedural outcomes [Mean difference of procedure time (minutes) -8.34; 95% CI -15.34- -1.33: Air Kerma (mGy) -90.1; 95% CI -107.5- -72.7: contrast volume (ml) -4.48; 95% CI -7.4- -1.6](FIGURE).
Conclusion: CT may be more accurate than conventional TEE-based procedural planning prior to percutaneous LAA occlusion and may lead to improved procedural outcomes. CT may be an underutilized yet valuable tool in procedural planning prior to percutaneous LAA occlusion.
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