Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion

Jonatan Gerard Nirmalan; Anders Kramer; Kasper Korsholm; Jesper Møller Jensen; Jens Erik Nielsen-Kudsk

doi:10.1007/s10840-023-01665-y

Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion

Jonatan Gerard Nirmalan, Anders Kramer, Kasper Korsholm, Jesper Møller Jensen, Jens Erik Nielsen-Kudsk

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing. Methods: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1–3) along with the underlying mechanism. Results: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), − 0.39 mm (± 2.43), and − 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment. Conclusion: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter. Graphical Abstract: (Figure presented.)

Original language	English
Journal	Journal of Interventional Cardiac Electrophysiology
Volume	67
Issue	4
Pages (from-to)	785-795
Number of pages	11
ISSN	1383-875X
DOIs	https://doi.org/10.1007/s10840-023-01665-y
Publication status	Published - Jun 2024

Keywords

Amplatzer Amulet
Cardiac computed tomography
Left atrial appendage
Left atrial appendage occlusion
Peri-device leak

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10.1007/s10840-023-01665-y

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@article{f789b8dfacee421e967fe2337273fc11,

title = "Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion",

abstract = "Background: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing. Methods: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1–3) along with the underlying mechanism. Results: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), − 0.39 mm (± 2.43), and − 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment. Conclusion: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter. Graphical Abstract: (Figure presented.)",

keywords = "Amplatzer Amulet, Cardiac computed tomography, Left atrial appendage, Left atrial appendage occlusion, Peri-device leak",

author = "Nirmalan, {Jonatan Gerard} and Anders Kramer and Kasper Korsholm and Jensen, {Jesper M{\o}ller} and Nielsen-Kudsk, {Jens Erik}",

note = "{\textcopyright} 2023. The Author(s).",

year = "2024",

month = jun,

doi = "10.1007/s10840-023-01665-y",

language = "English",

volume = "67",

pages = "785--795",

journal = "Journal of Interventional Cardiac Electrophysiology",

issn = "1383-875X",

publisher = "Springer",

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Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion. / Nirmalan, Jonatan Gerard; Kramer, Anders ; Korsholm, Kasper et al.
In: Journal of Interventional Cardiac Electrophysiology, Vol. 67, No. 4, 06.2024, p. 785-795.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion

AU - Nirmalan, Jonatan Gerard

AU - Kramer, Anders

AU - Korsholm, Kasper

AU - Jensen, Jesper Møller

AU - Nielsen-Kudsk, Jens Erik

PY - 2024/6

Y1 - 2024/6

N2 - Background: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing. Methods: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1–3) along with the underlying mechanism. Results: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), − 0.39 mm (± 2.43), and − 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment. Conclusion: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter. Graphical Abstract: (Figure presented.)

AB - Background: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing. Methods: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1–3) along with the underlying mechanism. Results: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), − 0.39 mm (± 2.43), and − 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment. Conclusion: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter. Graphical Abstract: (Figure presented.)

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KW - Cardiac computed tomography

KW - Left atrial appendage

KW - Left atrial appendage occlusion

KW - Peri-device leak

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U2 - 10.1007/s10840-023-01665-y

DO - 10.1007/s10840-023-01665-y

M3 - Journal article

C2 - 37882993

SN - 1383-875X

VL - 67

SP - 785

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JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

IS - 4

ER -

Computed tomography-based device-sizing in Amplatzer Amulet left atrial appendage occlusion

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