Comparison Between The Cardiac Computed Tomography Angiography And Transesophageal Echocardiography After Percutaneous Left Atrial Appendage Occlusion In Atrial Fibrillation Patients

Background:Stroke induced by intra-atrial thrombus is the most serious complication of atrial fibrillation,Wafarin is most common choice in thrombus prevention.However,side effects including bleeding,interaction with a large spectrum of food and drugs,changes in diets and illness of warfarin prevent widely use of this drug.Percutaneous transcatheter closure of left atrial appendage(PLAAO)has been proved to be as effective and safe as warfarin in preventing ischemic stroke and widely performed in China.To adjust postoperative antithrombotic regimen,post-intervention evaluations are usually performed using Transesophageal echocardiography(TEE)to monitor the(PDL)of occluder device residual leakage and instrument-related thrombus(DRT).However,as an invasive procedure,TEE is hard to tolerate for some patients.Moreover,the results of TEE might be greatly affected by the operator’s experience,.The non-invasive Cardiac computed tomography angiography(CCTA)is an alternative of TEE.and the comparison between this two methods is limited.Objective:We aimed to compare the results of CCTA and TEE in AF patients underwent PLAAO,and to explore the value of CCTA in the diagnosis of PDL and DRT after PLAAO.Methods:We enrolled patients with non-valvular atrial fibrillation who underwent PLAAO in the first affiliated Hospital of Kunming Medical University from July 2017 to November 2019.All patients had TEE and CCTA at the 45th day,6th month and 12th month after PLAAO.The rate of occluder device residual leakage and device-related thrombus were compared and analyzed,and the related factors of adverse events were analyzed.Results:A total of 61 patients were included.The success rate of PLAAO was 100%.39WATCHMANTM and 22LAMBRETM.The average age was 67.21±9.88 years old,and the proportion of males was 60.6%.The score of CHA2DS2-VASC was 3.29±1.22 and that of HAS-BLED was 3.03±3.82.61 patients followed up at 45th days,at 6th months and 12th months,There were respectively 45 and 23 patients followed up.TEE showing:at 45th days,the positive rate of PDL was 68.8%,31.1%at 6th months,8.7%at 12th months.CCTA showing:at 45th days,the positive rate of PDL was 83.6%,84.4%at 6th months,52.2%at 12th months.Until 6th months,only 1 patient was positive for DRT in both CCTA and TEE.PDL detected by CCTA was significantly higher than that by TEE at 45th days postoperatively,p<0.05,and it was still statistically significant at 6th months postoperatively,p<0.05.1 patient was hospitalized because of fundus hemorrhage,1 patient was hospitalized because of"cerebral infarction",and there was no operation-related death.Conclusion:After PLAAO,the detection rate of PDL in CCTA was higher than that in TEE,the detection rate of DRT was the same as that of TEE.The sensitivity of CCTA in detecting PDL was higher than that of TEE,and the sensitivity to DRT was the same as that of TEE.No patients dropped because of intolerance of CCTA,which indicated that CCTA had better tolerance than TEE,and might be a potential alternative of TEE as a routine follow-up after LAAO.PDL rate detected by CCTA was high in 45 days after operation,which indicated incomplete endothelialization at that time.The effective and safety of current program which recommended switching anticoagulants to antiplatelets in 45-day according to TEE need to be reassessed.