Computed Tomography-Fluoroscopy Fusion Guidance for Left Atrial Appendage Closure

Multimodality imaging is essential for the planning and execution of many of these procedures. With respect to left atrial appendage closure (LAAC) procedures, pre-procedural imaging with transesophageal echocardiography (TEE) and computed tomography (CT) is used to assess the anatomy of the left atrial appendage (LAA) and to size the closure device. Fluoroscopy, which is the workhorse of percutaneous procedures, has good temporal resolution but poor soft tissue resolution. Imaging modalities with good soft tissue resolution, such as TEE and intracardiac echocardiography (ICE), are, therefore, used in combination with fluoroscopy for procedural guidance. These imaging modalities are used separately during the procedure, and focus shifts between them at different points within the procedure. Fusion imaging leverages the advantages of complementary imaging modalities by combining fluoroscopy with its high temporal resolution and CT with its good soft tissue resolution for real-time percutaneous left atrial appendage closure guidance. CT-fluoroscopy fusion can lower procedure times, fluoroscopy times, radiation exposure, and contrast volume used. Also, CT-fluoroscopy fusion offers more successful first-time transseptal punctures, first-pass device deployment, and complete left atrial appendage seals.