The current standard of care for patients who underwent left atrial appendage closure (LAAC) is to have follow-up transesophageal echocardiogram (TEE) for device surveillance. TEE is an ultrasound of the heart done by placing a probe in the esophagus under conscious sedation. It does not use contrast but can be cumbersome to patients as it involves placing a probe in the esophagus. Cardiac computerized tomography angiography (cardiac CTA) is a non-invasive imaging modality that involves the use of certain types of x-rays, contrast (dye) and special computers to generate accurate images of the heart. Participants in this study will undergo both TEE and CTA on the same day 90 days after their LAAC procedure.
Participants will be in this research study for a period of 1 year, starting from the day of their scheduled LAAC procedure. Participants will undergo a TEE at 90 days after their procedure which is the standard of care imaging study after LAAC. As part of this study, participants will also undergo a cardiac CTA at 90 days as well. Participants will have a routine follow-up visit following device placement as per standard of care as well as a brief phone "check in" at 1 year.
Subjects >18 years old planned to undergo LAAC
eGFR ≥ 30 mL/min per 1.73 m2
Subjects below the age of 18
non-English speaking subjects
eGFR < 30 mL/min per 1.73 m2
Subjects with history of contrast allergy
Single group
Transesophageal echocardiography (TEE)
Procedure/SurgeryTEE will be performed using a 3D probe. TEE images will be acquired at the standard 0, 45, 90, and 135 degree views along with a 3D acquisition encompassing the entire LAA, device, left pulmonary vein and lateral mitral annular landmarks.
Cardiac CTA
Procedure/SurgeryCardiac CTA will be performed with ECG gating using systems with ≥ 64 detector rows and with temporal resolution that is at least 175 msec (rotation speed ≤ 350 msec for single source systems). Cardiac CTA images will be acquired for the entire cardiac cycle without ECG phase specific pulsing and with contrast appropriately timed for peak left atrial/arterial phase contrast enhancement. In addition, a targeted end systolic only delayed phase image set (45 seconds after the arterial phase scan and limited to the left atrium and appendage device) will be acquired.
LAA patency percentage associated with peri device leak (PDL) as measured by CT scan/TEE
LAA patency percentage associated with intra device leak (IDL) as measured by CT scan/TEE.
LAA patency percentage associated with a combination of both PDL and IDL as measured by CT scan/TEE.
Number of detected device-related thrombus (DRT) as measured by CT scan/TEE.
Average size of device measured in millimeters (mm)
Percent of compression as measured by CT scan/TEE
Percent compression is comprised by dividing the device diameter over the device size represented as one single score.
Average depth of implant measured in millimeters (mm)
Average hypo-attenuated thickening (HAT) measured in millimeters (mm)
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University Hospitals Cleveland Medical Center
Lead sponsor
Boston Scientific Corporation
Collaborator
