A Comprehensive Comparison of Left Atrial Appendage Closure Device Compression to Occlusion Rates

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Cardiovasc Comput Tomogr

Keywords

anticoagulation, atrial fibrillation, cardiac gated imaging, cerebrovascular accident, CHA2DS2-VASc score, clinical article, complication, computed tomographic angiography, conference abstract, echocardiograph, echocardiography, female, heart left atrium, human, left atrial appendage closure, left atrial appendage closure device, male, retrospective study

Abstract

Introduction: Left atrial appendage occlusion (LAAO) is a common intervention to reduce stroke for patients with atrial fibrillation who cannot tolerate anticoagulation. 45-day post-intervention ECG-gated computed tomography angiography (CCTA) is a less invasive alternative to transesophageal echocardiogram to determine procedural success. It is hypothesized that degree of device compression is related to successful LAAO. Methods: Retrospective analysis was performed on 50 consecutive patients who underwent post LAAO CCTA between June 2025 to January 2026. Average age 76.6±7.8 years, 27 (54%) male. Average CHA2DS2-VASc score was 4.2±1.3. Devices used include Amulet (Abbott Laboratories, Abbott Park, Illinois, USA) (n=4, 8%) and Watchman (Boston Scientific, Maple Grove, Minnesota, USA) (Watchman FLX: n=5, 10%, Watchman FLX Pro: n=41, 82%). Compression was determined by subtracting average linear dimensions at the device landing zone by its nominal size, then dividing by nominal device size. Occlusion was composite of Hounsfield units (HU) <100 from within the device and or distal appendage and ratio of HU of the nearby left atrium (LA) <0.25. Results: 29 patients were occluded by device LA HU ratio and the distal LAA LA HU ratios. No significant correlation was found between device compression and occlusion success within the device (r=-0.027) or in the residual distal appendage (r=-0.139). No significant correlation when stratified by device sizing tertiles: 20-24mm device to LA (r=-0.17), 27-28mm device to LA (r=-0.13), 31-40mm device to LA (r=-0.06). 7 (14%) had incomplete occlusion due to position from skirt leaks (n=4, 8%) and peridevice contrast channels (n=3, 6%). Conclusions: Manufacturers recommend ideal device compression ranges for device fitment (Watchman 10-30%, Amulet 10-20%). Our data suggests that compression is unlikely to relate to occlusion success but correlation to device stability requires further study. Preliminary data suggests that anatomic positioning is likely to play a greater role for successful occlusion. [Formula presented]

Volume

20

Issue

4

First Page

S107

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