• Jacqueline Saw, Peter Fahmy, Ryan Spencer, Roshan Prakash, Patrick McLaughlin, Savvas Nicolaou, and Michael Tsang.
• Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
• J. Cardiovasc. Electrophysiol. 2016 Apr 1; 27 (4): 414-22.

BackgroundLeft atrial appendage (LAA) closure requires accurate preprocedural measurements, and trans-esophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy can be utilized. However, correlations between these measurements remain inadequately assessed.MethodsPatients who underwent LAA closure at Vancouver General Hospital who had baseline LAA measurements by CCTA, TEE, and fluoroscopy were included in this analysis. CCTAs were performed with prospective-ECG-gating with Toshiba 320-detector or Siemens second generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation.™ LAA maximal dimensions were obtained for all patients at: (1) Amplatzer Cardiac Plug (ACP)/Amulet landing zone 10 mm within orifice, (2) WATCHMAN ostium, and (3) WATCHMAN depth measurements. Correlations and agreements were compared.ResultsWe report 50 consecutive patients who underwent LAA closure (8 ACP, 10 Amulet, 32 WATCHMAN). Average age was 75.2 ± 8.7 years, mean CHADS2 score 3.0 ± 1.3, and CHA2 DS2 -VASc 4.7 ± 1.5. Procedural device implantation success was 100%. For ACP landing zone, mean maximal measurements were 24.1 ± 4.7 mm with CCTA, 22.3 ± 4.9 mm TEE, and 19.9 ± 5.6 mm fluoroscopy (P < 0.001); R value 0.81 fluoroscopy/CTA, 0.67 fluoroscopy/TEE, and 0.80 CTA/TEE. For WATCHMAN ostium, mean maximal measurements were 25.8 ± 4.7 mm CCTA (P < 0.001 vs. fluoroscopy, P = 0.16 vs. TEE), 25.1 ± 4.4 mm TEE (P = 0.016 vs. fluoroscopy), and 23.8 ± 4.9 mm fluoroscopy; R value 0.71 fluoroscopy/CTA, 0.65 fluoroscopy/TEE, and 0.74 CTA/TEE. Depth measurements were 34.3 ± 5.7 mm with CCTA, 31.1 ± 6.5 mm TEE, and 27.8 ± 7.1 mm fluoroscopy (all P < 0.01); and correlations with R value 0.28 fluoroscopy/CTA, 0.22 fluoroscopy/TEE, and 0.56 CTA/TEE.ConclusionsAll 3 imaging modalities correlated with ACP landing zone and WATCHMAN ostium measurements, with CCTA providing the largest measurements, followed by TEE and fluoroscopy.© 2016 Wiley Periodicals, Inc.

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