Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion

JACC Cardiovasc Interv. 2020 Feb 10;13(3):277-292. doi: 10.1016/j.jcin.2019.08.054. Epub 2019 Oct 30.

Abstract

Transcatheter left atrial appendage occlusion is an increasingly used alternative to oral anticoagulation in selected patients with atrial fibrillation. Pre-procedural imaging is a prerequisite to a successful intervention, with transesophageal echocardiography as the current gold standard. However, cardiac computed tomography offers improved imaging with high-quality multiplanar and 3-dimensional reconstructed images. Nevertheless, the lack of a standardized imaging protocol has slowed the adoption of cardiac computed tomography into clinical practice. On the basis of current research and expert consensus, this paper provides a protocol for the preparation, acquisition, and interpretation of cardiac computed tomographic imaging in pre-procedural planning of left atrial appendage occlusion.

Keywords: CT scanner requirements; contrast injection; left atrial appendage thrombus detection and measurements; patient preparation.

Publication types

  • Practice Guideline
  • Review
  • Video-Audio Media

MeSH terms

  • Atrial Appendage / diagnostic imaging*
  • Atrial Appendage / physiopathology
  • Atrial Fibrillation / diagnostic imaging*
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Consensus
  • Humans
  • Imaging, Three-Dimensional / standards
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted / standards
  • Tomography, X-Ray Computed / standards*
  • Treatment Outcome