title: Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9 jsaw@mail.ubc.ca.
authors: Jacqueline
authors: J
authors: Saw
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Peter
authors: P
authors: Fahmy
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Peggy
authors: P
authors: DeJong
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Mathieu
authors: M
authors: Lempereur
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Ryan
authors: R
authors: Spencer
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Michael
authors: M
authors: Tsang
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Kenneth
authors: K
authors: Gin
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: John
authors: J
authors: Jue
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: John
authors: J
authors: Mayo
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Patrick
authors: P
authors: McLaughlin
authors: Divisions of Cardiology and Radiology, Vancouver General Hospital, 2775 Laurel Street, Level 9, Vancouver, British Columbia, Canada V5Z1M9.
authors: Savvas
authors: S
authors: Nicolaou
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography; D020878:Device Removal; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol
keywords: Amplatzer cardiac plug; Amulet; WATCHMAN; cardiac CTA; left atrial appendage closure