Comparative Study Of Multimodality Imaging Measurement And Device-Related Thrombus In LAAC

Background: The left atrial appendage(LAA)has a variety of anatomical morphology,accurately measuring its opening and depth,and selecting the appropriate size of the occluder is the key point of the Watchman left atrial appendage closure(LAAC).This study intends to analyze the correlation,consistency and influence of occluder selection by fluoroscopy,transesophageal echocardiography(TEE)and computed tomography angiography(CTA)and explore the rational application of multimodality imaging measurement in LAAC.Method: 48 patients with non-valvular atrial fibrillation who have underwent LAAC with all fluoroscopy,TEE and CTA available at the Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine from April 2017 to December 2017 were included.Three imaging modality were used to measure the maximum ostium and depth of the LAA,and the correlation and consistency among the three methods were analyzed and compared with the actual occluder size.Results: There is good correlation and consistency of maximal ostium between TEE and fluoroscopy.CTA is correlated with TEE and fluoroscopy,but not consistent withthem.There is a correlation between the depth measured by the three modalities,but there is no consistency.The ostium of the LAA measured by CTA is the largest,while TEE is the smallest.TEE and fluoroscopy have a high degree of matching with the actual selected occluder,while the measurement of the CTA is sometimes larger.Conclusions: TEE and fluoroscopy can accurately measure the ostium and depth of the LAA.The correlation and consistency of between them are good,and can effectively guide the selection of the Watchman occluder.The ostium and depth of CTA are not consistent with TEE and angiography and the deviation from the actual selected occluder is large,but this may be due to research errors,and further verification is needed.Background: After the left atrial appendage occluder is implanted,contact between the metal surface and the blood circulation may result in the formation of devicerelated thrombus(DRT).Patients with traditional warfarin anticoagulation after surgery had poor compliance.The new oral anticoagulants(NOACs)dabigatran is easy to take and can reduce the risk of stroke related to non-valvular atrial fibrillation,but the efficacy and safety is still not clear.Method: During the period from October 2016 to September 2017,84 patients with non-valvular atrial fibrillation underwent Watchman left atrial appendage closure in the Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine.The postoperative anticoagulant drugs(warfarin or 110 mg dabigatran)were selected according to the patient’s wishes.The incidence of DRT was compared between the two groups,and the possible risk factors were analyzed.Results: There was no ischemic stroke or major bleeding in patients taking dabigatran during the one-year follow-up period.One patient who took warfarin died of intracranial hemorrhage,and another patient developed an ischemic stroke after 2M months of warfarin withdrawal.TEE findings at 2 months postoperatively showed that the incidence of DRT in the dabigatran group(6 cases,15.79%)was higher than that in the warfarin group(1 case,2.17%).No DRT-related thrombotic events were observed in either group..Conclusions: Compared with warfarin,the use of 110 mg dabigatran anticoagulation twice daily after left atrial appendage was safe and effective,and the major adverse events(MAEs)did not increase after one year,and the incidence of bleeding events may be lower than warfarin;the use of 110 mg dabigatran anticoagulation after LAAC may increase the incidence of DRT compared with warfarin,especially in patients with high BMI.