Left Atrial Appendage Closure With Amplatzer Septal Occluder in Patients With Atrial Fibrillation: CT-Based Morphologic Considerations

Objectives. This study analyzed left atrial appendage (LAA) dimensions measured by computed tomography (CT) scan to define optimal selection of Amplatzer septal occluders for LAA closure. Background. Patients with atrial fibrillation and contraindications to anticoagulation have limited options for LAA closure until approval of dedicated closure devices. Off-label use of available cardiac devices represents one option. Methods. All consecutive patients undergoing LAA occlusion with an Amplatzer device who had undergone CT scanning were included. Numerous dimensions of the LAA were measured in order to optimally select a device that would simultaneously provide good anchoring and good sealing of the LAA. Results. Of 11 eligible patients, 8 had successful Amplatzer deployment. In all successful cases, the putative "left atrial" disc was well matched to the "landing zone" of the LAA, proving good anchoring. The proximal (putative "right atrial") disc was sized to cover the LAA orifice. The failed cases shed light on procedural variables. Conclusions. LAA occlusion with an Amplatzer device is a viable option for patients with atrial fibrillation and contraindications to anticoagulation. Careful attention to LAA dimensions as measured on CT scan assists in optimizing device selection.