Correlation between measurement of left atrial appendage orifice by three-dimensional transesophageal echocardiography, two-dimensional transesophageal echocardiography and digital subtraction angiography and the size of successfully implanted occluder in left atrial appendage occlusion

Objective To explore the correlation between measurement of left atrial appendage orifice by three-dimensional transesophageal echocardiography (3D-TEE), two-dimensional transesophageal echocardiography (2D-TEE), digital subtraction angiography (DSA) and the size of successfully implanted occluder in left atrial appendage occlusion (LAAO).

Methods Patients with non-valvular atrial fibrillation (NVAF) who underwent LAAO in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 3, 2019 to January 25, 2020 were retrospectively selected. The maximum diameter of left atrial appendage was evaluated by 2D-TEE and 3D-TEE before operation, and was measured by DSA left atrial appendage angiography during operation. The correlation between the maximum diameter of left atrial appendage orifice measured by three imaging methods and the size of the final implanted occluder was compared.

Results A total of 180 patients were included, with an average age of (68.25±9.15) years old, 112 (62.2%) were males and 68 (37.8%) were females. The CHA₂DS₂-VASc score was 3.56±1.76, and the anterior posterior diameter of left atrium was (46.00±6.31) mm. Watchman left atrial appendage occluder was successfully implanted in all patients, and the average size of final implanted occluder was (28.1±3.2) mm. The maximum diameter of the left atrial appendage orifice measured by 3D-TEE before operation was (24.67±2.67) mm, significantly higher than that measured by 2D-TEE (20.95±2.91 mm, P < 0.001) and DSA (23.91±2.79 mm, P < 0.001). Correlation analysis showed that the maximum diameter of the left atrial appendage orifice measured by 3D-TEE, 2D-TEE and DSA was positively correlated with the size of the final implanted occluder (r＝0.862, 0.614, 0.656; P < 0.001).

Conclusions The maximum diameter of the left atrial appendage orifice measured by 3D-TEE through three-dimensional volume imaging was significantly higher than that measured by 2D-TEE and DSA, and had the strongest correlation with the size of successfully implanted occluder.