title: CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety.
abstract: OBJECTIVE
  We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes.
  
  
  RESULTS
  Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection.
  
  
  CONCLUSIONS
  In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases.
authors.affiliation: Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.|Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
authors.forename: Adil
authors.initials: A
authors.lastname: Rajwani
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Nelson
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Masoumeh G
authors.initials: MG
authors.lastname: Shirazi
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
authors.forename: Patrick J S
authors.initials: PJS
authors.lastname: Disney
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Karen S L
authors.initials: KSL
authors.lastname: Teo
authors.affiliation: MonashHeart and Department of Medicine, Monash University, Melbourne, VIC 3168, Australia.
authors.forename: Dennis T L
authors.initials: DTL
authors.lastname: Wong
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Young
authors.affiliation: Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods; D061214:Patient Safety; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: CT; LAA; Watchman; left atrial appendage closure; procedural hazard; safety