Pre-procedural Planning for Left Atrial Appendage Closure with Cardiac Computed Tomography Angiography

The size and shape of the left atrial appendage (LAA) widely vary among individuals. Therefore, imaging guidance for the LAAC (left atrial appendage closure) procedure is of utmost importance to procedural success, as it helps guide the choice of device, size of device, and device delivery system. CTA may be performed for planning left atrial appendage closure (LAAC) as a noninvasive alternative to transesophageal echocardiography (TEE). TEE has thus since served as the gold standard for the LAAC procedure, and this has persevered, in part, because of the extensive availability of TEE and the widespread experience with this imaging modality. However, TEE has some notable disadvantages compared with cardiac computed tomography angiography (CTA). CTA may offer a superior, noninvasive alternative with better anatomical segmentation for the LAA and its surrounding structures. CTA may also improve device sizing accuracy over TEE when used in experienced centers. Commercially available software packages provide sizing measurements, and information about surrounding cardiac structures may improve device selection strategy over TEE. CTA-planned LAAC may also improve procedure efficiency and can be incorporated into a same-day imaging strategy.