Abstract 12065: Optimal Projections for the Angiographic Imaging and the Percutaneous Closure of the Left Atrial Appendag:. Lessons Learned From the Intraprocedural Reconstruction of the Left Atrium and the Pulmonary Veins
Introduction: Percutaneous left atrium appendage (LAA) obliteration is a new alternative strategy for prevention of embolic events in patients with atrial fibrillation (AF) and contraindications to anticoagulation. However, selective angiography of the LAA in standard fluoroscopic projections as guidance for device implantation does not always achieve optimal depiction of the individual LAA-ostium anatomy.
Methods: The intraprocedural rotational angiography of 100 patients (67% men, age: 60 ± 12 years) with AF and indication for left atrium (LA) ablation was evaluated by two independent physicians in 33 angiographic projections, from right anterior oblique (RAO) 80° to left anterior oblique (LAO) 80°. The optimal projections of the LAA ostium diameter were arbitrary defined according to the following criteria. Sagittal plane: (i) clear identification of both superior and inferior segments of the LA-LAA junction and (ii) no overlapping between LA and LAA ostium. Frontal plane: (i) clear identification of all four quadrants of the LAA ostium and (ii) visualisation of the maximal horizontal ostial diameter.
Results: The optimal ostial fluoroscopic projection for the LAA ostium in a sagittal plane was RAO 30° in 82 out of 100 patients (82%). Every 5° deviation from RAO 30° led to a 10% reduction of the optimally depicted LAA-ostia. The optimal ostial projection in a frontal plane for the LAA ostium was LAO 40° in 60 out of 100 patients (60%) and every 5° deviation led to a reduction of the optimally depicted LAA-ostia of about 15%, so that the anteroposterior diameter of LAA was not visible in RAO projections.
Conclusion: If selective angiography of the LAA ostium anatomy is performed to facilitate the implantation of an occlusion device, fluoroscopic projections should be carefully selected to avoid suboptimal visualisation. The preselected projections proposed in our study: RAO 30° and LAO 40° result in optimal sagittal and frontal angiographic projections of the LAA ostium respectively in the majority of patients.
- © 2011 by American Heart Association, Inc.