Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion

Yeong Min Lim, Jung Sun Kim, Tae Hoon Kim, Jae Sun Uhm, Chi Young Shim, Boyoung Joung, Geu Ru Hong, Moon Hyoung Lee, Yang Soo Jang, Hui Nam Pak

Research output: Contribution to journalArticle

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Abstract

Background The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. Methods We included 35 patients (age 67.5 ± 10.9 years, CHA2DS2VASc 4.2 ± 1.6, HAS-BLED 3.7 ± 1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4%) underwent multiple episodes of CT follow-up. Results 1. The proportions of patients with LAA-CF were 54.2% (19/35) at 6 months, 55.5% (5/9) at 6–18 months, and 33.3% (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8 ± 1.5 months (66.6% in WATCHMAN and 36.3% in ACP; p = 0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0 ± 11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08–1.96), p = 0.013, adjusted for age, sex, and device type]. Conclusions Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.

Original languageEnglish
Pages (from-to)571-577
Number of pages7
JournalJournal of Cardiology
Volume70
Issue number6
DOIs
Publication statusPublished - 2017 Dec

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Atrial Appendage
Tomography
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Lim, Yeong Min ; Kim, Jung Sun ; Kim, Tae Hoon ; Uhm, Jae Sun ; Shim, Chi Young ; Joung, Boyoung ; Hong, Geu Ru ; Lee, Moon Hyoung ; Jang, Yang Soo ; Pak, Hui Nam. / Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion. In: Journal of Cardiology. 2017 ; Vol. 70, No. 6. pp. 571-577.
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title = "Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion",
abstract = "Background The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. Methods We included 35 patients (age 67.5 ± 10.9 years, CHA2DS2VASc 4.2 ± 1.6, HAS-BLED 3.7 ± 1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4{\%}) underwent multiple episodes of CT follow-up. Results 1. The proportions of patients with LAA-CF were 54.2{\%} (19/35) at 6 months, 55.5{\%} (5/9) at 6–18 months, and 33.3{\%} (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8 ± 1.5 months (66.6{\%} in WATCHMAN and 36.3{\%} in ACP; p = 0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0 ± 11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08–1.96), p = 0.013, adjusted for age, sex, and device type]. Conclusions Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.",
author = "Lim, {Yeong Min} and Kim, {Jung Sun} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Shim, {Chi Young} and Boyoung Joung and Hong, {Geu Ru} and Lee, {Moon Hyoung} and Jang, {Yang Soo} and Pak, {Hui Nam}",
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Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion. / Lim, Yeong Min; Kim, Jung Sun; Kim, Tae Hoon; Uhm, Jae Sun; Shim, Chi Young; Joung, Boyoung; Hong, Geu Ru; Lee, Moon Hyoung; Jang, Yang Soo; Pak, Hui Nam.

In: Journal of Cardiology, Vol. 70, No. 6, 12.2017, p. 571-577.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion

AU - Lim, Yeong Min

AU - Kim, Jung Sun

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Shim, Chi Young

AU - Joung, Boyoung

AU - Hong, Geu Ru

AU - Lee, Moon Hyoung

AU - Jang, Yang Soo

AU - Pak, Hui Nam

PY - 2017/12

Y1 - 2017/12

N2 - Background The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. Methods We included 35 patients (age 67.5 ± 10.9 years, CHA2DS2VASc 4.2 ± 1.6, HAS-BLED 3.7 ± 1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4%) underwent multiple episodes of CT follow-up. Results 1. The proportions of patients with LAA-CF were 54.2% (19/35) at 6 months, 55.5% (5/9) at 6–18 months, and 33.3% (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8 ± 1.5 months (66.6% in WATCHMAN and 36.3% in ACP; p = 0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0 ± 11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08–1.96), p = 0.013, adjusted for age, sex, and device type]. Conclusions Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.

AB - Background The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. Methods We included 35 patients (age 67.5 ± 10.9 years, CHA2DS2VASc 4.2 ± 1.6, HAS-BLED 3.7 ± 1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4%) underwent multiple episodes of CT follow-up. Results 1. The proportions of patients with LAA-CF were 54.2% (19/35) at 6 months, 55.5% (5/9) at 6–18 months, and 33.3% (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8 ± 1.5 months (66.6% in WATCHMAN and 36.3% in ACP; p = 0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0 ± 11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08–1.96), p = 0.013, adjusted for age, sex, and device type]. Conclusions Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.

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