Variations in Procedural Planning Modalities
Due to the variable anatomy of any given patient’s LAA, pre-procedural
planning is imperative to select the correct device size and ensure the
feasibility and safety of implantation. Initially, device sizing and
procedural guidance were conducted with trans-esophageal
echocardiography (TEE) [4]. However, TEE during the procedure often
requires general anesthesia necessitating overnight observation, and has
been shown to undersize the estimated LAA orifice, leading to incorrect
device size selection [5]. These pitfalls led to the advent of
computed tomography (CT) for procedural planning and device selection
[6]. Given its cross-sectional nature, CT appears to provide a
better estimation of the diameter of the LAA orifice and the general
area, allowing for careful device selection [7]. However, CT also
has drawbacks, mainly the need for iodinated contrast, which limits its
use in patients with chronic renal disease.