Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
Cardiac computed tomography following Watchman FLX implantation : device-related thrombus or device healing? / Kramer, Anders Dahl; Korsholm, Kasper; Jensen, Jesper Møller et al.
In: European Heart Journal Cardiovascular Imaging, Vol. 24, No. 2, 02.2023, p. 250-259.Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
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TY - JOUR
T1 - Cardiac computed tomography following Watchman FLX implantation
T2 - device-related thrombus or device healing?
AU - Kramer, Anders Dahl
AU - Korsholm, Kasper
AU - Jensen, Jesper Møller
AU - Nørgaard, Bjarne Linde
AU - Peelukhana, Srikara
AU - Herbst, Thomas
AU - Horton, Rodney
AU - Kar, Saibal
AU - Saw, Jacqueline
AU - Alkhouli, Mohamad
AU - Nielsen-Kudsk, Jens Erik
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/2
Y1 - 2023/2
N2 - AIMS: Cardiac computed tomography (CT) is increasingly utilized during follow-up after left atrial appendage closure (LAAC). Hypoattenuated thickening (HAT) is a common finding and might represent either benign device healing or device-related thrombosis (DRT). The appearance and characteristics of HAT associated with the Watchman FLX have not been previously described. Therefore, we sought to investigate cardiac CT findings during follow-up after Watchman FLX implantation with a focus on HAT and DRT.METHODS AND RESULTS: Retrospective single-centre, observational study including all patients with successful Watchman FLX implantation and follow-up cardiac CT between March 2019 and September 2021 (n = 244). Blinded analysis of CT images was performed describing the localization, extent, and morphology of HAT and correlated to imaging and histology findings in a canine model. Relevant clinical and preclinical ethical approvals were obtained.Overall, HAT was present in 156 cases (64%) and could be classified as either subfabric hypoattenuation (n = 59), flat sessile HAT (n = 78), protruding sessile HAT (n = 16), or pedunculated HAT (n = 3). All cases of pedunculated HAT and five cases of protruding sessile HAT were considered as high-grade HAT (n = 7). Subfabric hypoattenuation and flat sessile HAT correlated with device healing and endothelialization in histological analysis of explanted devices.CONCLUSION: Subfabric hypoattenuation and flat sessile HAT are frequent CT findings for Watchman FLX, likely representing benign device healing and endothelialization. Pedunculated HAT and protruding HAT are infrequent CT findings that might represent DRT.
AB - AIMS: Cardiac computed tomography (CT) is increasingly utilized during follow-up after left atrial appendage closure (LAAC). Hypoattenuated thickening (HAT) is a common finding and might represent either benign device healing or device-related thrombosis (DRT). The appearance and characteristics of HAT associated with the Watchman FLX have not been previously described. Therefore, we sought to investigate cardiac CT findings during follow-up after Watchman FLX implantation with a focus on HAT and DRT.METHODS AND RESULTS: Retrospective single-centre, observational study including all patients with successful Watchman FLX implantation and follow-up cardiac CT between March 2019 and September 2021 (n = 244). Blinded analysis of CT images was performed describing the localization, extent, and morphology of HAT and correlated to imaging and histology findings in a canine model. Relevant clinical and preclinical ethical approvals were obtained.Overall, HAT was present in 156 cases (64%) and could be classified as either subfabric hypoattenuation (n = 59), flat sessile HAT (n = 78), protruding sessile HAT (n = 16), or pedunculated HAT (n = 3). All cases of pedunculated HAT and five cases of protruding sessile HAT were considered as high-grade HAT (n = 7). Subfabric hypoattenuation and flat sessile HAT correlated with device healing and endothelialization in histological analysis of explanted devices.CONCLUSION: Subfabric hypoattenuation and flat sessile HAT are frequent CT findings for Watchman FLX, likely representing benign device healing and endothelialization. Pedunculated HAT and protruding HAT are infrequent CT findings that might represent DRT.
KW - Animals
KW - Atrial Fibrillation
KW - Dogs
KW - Echocardiography, Transesophageal
KW - Retrospective Studies
KW - Thrombosis/diagnostic imaging
KW - Tomography
KW - Treatment Outcome
U2 - 10.1093/ehjci/jeac222
DO - 10.1093/ehjci/jeac222
M3 - Journal article
C2 - 36336848
VL - 24
SP - 250
EP - 259
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
SN - 1525-2167
IS - 2
ER -