Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Interventions, 16(11), 1317–1328. https://doi.org/10.1016/j.jcin.2023.05.008 Dr. John-Ross D. Clarke et al.
Points
- The research paper investigated the impact of pre-procedure imaging on left atrial appendage occlusion (LAAO) procedures using data from the National Cardiovascular Data Registry LAAO Registry.
- Pre-procedure computed tomography (CT) or cardiac magnetic resonance (CMR) was used in 18.2% of the 114,384 LAAO procedures analyzed.
- Pre-procedure CT/CMR was associated with higher rates of implantation success (93.4%), device success (91.2%), and procedural success (89.4%) compared to procedures without preprocedural imaging.
- Pre-procedure CT/CMR was independently associated with a slightly increased likelihood of successful LAAO implantation (OR: 1.08), device success (OR: 1.10), and procedural success (OR: 1.07).
- The preprocedural CT/CMR use did not significantly correlate with major adverse events (MAE) during LAAO procedures (OR: 1.02), indicating its safety and reasonable use in the pre-procedure phase.
Summary
This research paper aimed to elucidate the impact of pre-procedure imaging on the safety and effectiveness of left atrial appendage occlusion (LAAO) procedures. Leveraging data from the National Cardiovascular Data Registry LAAO Registry, the study examined patients who underwent attempted LAAO using the WATCHMAN and WATCHMAN FLX devices from January 2016 to June 2021. Among the 114,384 procedures analyzed, pre-procedure computed tomography (CT) or cardiac magnetic resonance (CMR) was utilized in 18.2% of cases, amounting to 20,851 procedures.
The study provided valuable insights into the utilization patterns of pre-procedure CT/CMR, identifying higher usage rates in government and university hospitals and hospitals situated in the Midwest and South regions of the United States. Conversely, patients with uncontrolled hypertension, abnormal renal function, and no prior thromboembolism had lower rates of preprocedural imaging.
The researchers analyzed several key outcome measures to assess the effectiveness of pre-procedure CT/CMR. The cohort reported that the overall rates of implantation, device, and procedure success were 93.4%, 91.2%, and 89.4%, respectively. Furthermore, pre-procedure CT/CMR was found to be independently associated with a slightly increased likelihood of achieving implantation success (OR: 1.08; 95% CI: 1.00-1.17), device success (OR: 1.10; 95% CI: 1.04-1.16), and procedural success (OR: 1.07; 95% CI: 1.02-1.13).
The study also evaluated major adverse events (MAE) associated with pre-procedure CT/CMR use. MAE was uncommon, observed in only 2.3% of cases, and the study did not find any significant association between the use of preprocedural imaging and the occurrence of these events (OR: 1.02; 95% CI: 0.92-1.12).
In conclusion, the research demonstrates that pre-procedure CT/CMR is linked to a modestly improved likelihood of successful LAAO implantation, indicating its potential role in enhancing the overall success of LAAO procedures. While the magnitude of the benefit appears to be minor, preprocedural imaging was deemed safe, as it was not associated with an increased risk of major adverse events. These findings provide valuable evidence for clinicians when considering the implementation of pre-procedure CT/CMR in LAAO procedures, prompting further investigations to explore its specific utility in clinical practice.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S1936879823008294
References Clarke, J.-R. D., Higgins, A. Y., Wang, Y., Faridi, K. F., Curtis, J. A., Freeman, J. V., & Friedman, D. J. (2023). Impact of preprocedure imaging for left atrial appendage occlusion. JACC: Cardiovascular Interventions, 16(11), 1317–1328. https://doi.org/10.1016/j.jcin.2023.05.008
