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

• Published in: JACC. Cardiovascular interventions Vol. 13; no. 3; pp. 277 - 292
• Main Authors: Korsholm, Kasper, Berti, Sergio, Iriart, Xavier, Saw, Jacqueline, Wang, Dee Dee, Cochet, Hubert, Chow, Danny, Clemente, Alberto, De Backer, Ole, Møller Jensen, Jesper, Nielsen-Kudsk, Jens Erik
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 10.02.2020
• Subjects: contrast injection; CT scanner requirements; left atrial appendage thrombus detection and measurements; patient preparation; LAAO; contrast injection; AF; patient preparation; ECG; left atrial appendage thrombus detection and measurements; CT scanner requirements; LAA; 3D; CT; ALARA; TEE; BMI
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2019.08.054

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. [Display omitted] •Cardiac CT is increasingly used to plan transcatheter LAAO.•High-quality multiplanar and 3D imaging allow accurate device sizing and efficient LAAO.•A standardized protocol for cardiac CT is paramount for a high-quality result.•Pre-procedural cardiac CT may improve the accuracy, efficacy, and safety of LAAO.