Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review & meta-analysis

ABSTRACT

Background

Inaccurate sizing of left atrial appendage (LAA) occlusion devices is associated with increased stroke risk. We compared the LAA size to implant the Watchman device assessed by computed tomography (CT) to transesophageal echocardiography (TEE).

Methods

Databases were searched to identify studies comparing LAA anatomical measurements and procedural outcomes across imaging modalities for the Watchman device implantation.

Results

Seven studies were included in the analysis (242 patients on TEE, and 232 on CT). The LAA orifice was larger when sized with CT compared to TEE (CT mean vs TEE SMD 0.30 mm, 95%CI 0.09–0.51 mm, P < 0.01; and CT max vs TEE SMD 0.69 mm, 95%CI 0.51–0.87 mm, P < 0.001). Additionally, CT, including CT-based 3-dimensional models, had higher odds of predicting correct device size compared to TEE (OR 1.64; 95%CI 1.05–2.56; P = 0.03). CT resulted in a lower fluoroscopy time vs TEE (SMD −0.78 min, 95% CI −1.39 to −0.18, P = 0.012). No significant differences were found in device clinical outcomes.

Conclusion

Compared to TEE, CT resulted in larger LAA orifice measurements, improved odds of predicting correct device size, and reduced fluoroscopy time in patients undergoing LAA occlusion with the Watchman device. There were no significant differences in other procedural outcomes.

KEYWORDS:

• Watchman
• watchman FLX
• left atrial appendage closure
• CT
• TEE

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership, or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Y Sattar: Conceptualization, Methodology, Software, Formal analysis, Writing original draft, Review & editing.

R Kompella: Conceptualization, Methodology, Data Collection, Writing original draft, Review & editing.

B Ahmad: Writing original draft, Review & editing.

M Aamir: Writing original draft, Review & editing.

A-R Suleiman: Writing original draft, Review & editing.

M Zghouzi: Writing original draft, Review & editing, Journal formatting.

W Ullah: Writing original draft, Review & editing.

IY Elgendy: Writing original draft, Review & editing, Supervision.

S Balla: Writing original draft, Review & editing, Supervision.

A Kawsara: Writing original draft, Review & editing, Supervision.

MC Alraies: Conceptualization, Writing original draft, Review & editing, Supervision.

Additional information

Funding

This paper was not funded.