Real Time Three-Dimensional Transesophageal Echocardiography-Guided Placement of Left Atrial Appendage Occlusion Device

real time three-dimensional transesophageal echocardiography (3D TEE) is a novel imaging technique whose full utility is still being evaluated. We present a case utilizing 3D TEE for percutaneous placement of a left atrial appendage occlusion device. This evolving technology has potential application in other cardiovascular interventional procedures.     

Percutaneous Left Atrial Appendage Closure With the Ultraseal Device: Insights From the Initial Multicenter Experience

Objectives

This study sought to evaluate the feasibility, safety, and efficacy of the Ultraseal device for left atrial appendage closure (LAAC) (Cardia, Eagan, Minnesota) in patients with nonvalvular atrial fibrillation at high bleeding risk.

Incomplete Endothelialization of Left Atrial Appendage Occlusion Device 10 Months After Implantation

Incomplete Endothelialization of Left Atrial Appendage . We describe the case of a 74‐year‐old man with Rendu Osler Weber syndrome affected by permanent atrial fibrillation, who underwent percutaneous placement of a 24‐mm Watchman left atrial appendage system. After anticoagulation therapy dismissal, he had a transient ischemic attack (TIA). Therefore he underwent surgical removal of the device, ablation of atrial fibrillation with Maze IV procedure and biatrial reduction. Very interestingly, no significant endothelialization of the device was observed 10 months after implantation. In conclusion, this case is important because, to our knowledge, it is the first finding of Watchman device with lack of endothelialization. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1384‐1385, December 2012)     

Correlation of Left Atrial Diameter by Echocardiography and Left Atrial Volume by Computed Tomography

Introduction: For patients undergoing catheter ablation of atrial fibrillation (AF), left atrial size is a predictor of recurrence of AF during follow-up. For this reason, major clinical trials have used a left atrial diameter (LAD) of more than 5.0 or 5.5 cm, assessed by echocardiography, as an exclusion criterion for patients deemed candidates for ablation of AF. However, whether LAD accurately reflects true left atrial size has not been systematically investigated. Therefore, the purpose of this study was to test the hypothesis that LAD, measured by echocardiography, accurately correlates to left atrial volume measured by computed tomography (CT).
Methods and Results: We included 50 patients (mean age 56 ± 12 years, five female) with symptomatic AF (40% paroxysmal, 60% persistent), referred for catheter ablation. In each patient, transthoracic echocardiography was performed. Additionally, all patients underwent CT using a 64-slice CT scanner. Left atrial volume was calculated by manually tracing left atrial area on each CT cross-sectional image. Patients had a mean LAD measured by echocardiography of 4.5 ± 0.7 cm, ranging from 2.9 to 5.7 cm. Left atrial volume measured by CT ranged from 67 mL to 270 mL with a mean value of 146 ± 49 mL. A poor correlation was noted between LAD and left atrial volume, r = 0.49 (P < 0.001).
Conclusion: LAD measured by echocardiography correlates poorly with left atrial volume measured by CT in patients with AF. As a result, selecting patients with AF for treatment with catheter ablation should not be based on an echocardiographic-derived LAD alone.