Abstract 19825: Left Atrial Appendage Sizing for Closure - The Impact of Volume Loading
Introduction: Left atrial appendage (LAA) closure is an accepted alternative to oral anticoagulation in patients with non valvular AF at high risk of bleeds. Efficacy of the device requires a good seal across the orifice. Careful sizing is vital to successful implantation. In our institution, a preprocedure TEE is performed to assess the suitability of the LAA for closure and to perform preliminary measurements. During the procedure, we have observed the LAA dimensions to increases after the administration of fluid to fasting patients. It has been our practice therefore, to re-size the LAA immediately prior to implant. We decided to retrospectively review our data to ascertain the impact of volume loading on device size.
Methods: A retrospective review of TEE data of patients who had a WATCHMAN implanted between 2009 and 2015. LA dimensions measured on the preprocedure TEE were compared to the intraprocedure TEE after a volume load of 500-1000mls of gelosfusin aiming for a mean LA pressure of >12mmHg.
Results: Of 123 LAA closures using WATCHMAN device, data on both the pre- and intraprocedure LAA measurements were available on 41 patients. The average maximum orifice diameter preprocedure was 21.06mm (SD 3.62) with the depth being 25.77mm (SD 4.97). After volume loading, the average LA pressure achieved was 14.63mmHg (SD 2.86). The average maximum diameter of the LAA orifice after volume loading increased to 22.99mm (SD 3.41) and the longest depth to 29.68mm (SD 5.41). This results in an average orifice diameter increase of 1.93mm (p<0.0005) and depth increase of 3.91mm (p<0.0005). The average device size chosen was 27mm. Twenty nine (70.7%) patients achieved 8-20% compression with the remainder achieving >20%. Interval TEE at 6 weeks were available in 28 (68.29%) patients all of which were described as well seated.
Conclusion: Volume status of the patient greatly affects the LAA dimensions and size of device chosen. Our pre-procedure measurements would have resulted in implantation of a 24mm device in the majority of patients. Statistically significant changes in LAA size post volume loading resulted in the majority of patients receiving a 27mm device. The excellent seal achieved at follow up TEE further confirms the importance of volume loading for accurate device sizing.
Author Disclosures: A. McInerney: None. H. Hussein: None. B. McAdam: None. D. Foley: None.
- © 2016 by American Heart Association, Inc.