Thromboembolic stroke is the most serious complication in patient suffering from Atrial Fibrillation. Thrombus has a predilection to form in the left atrial appendage. Accordingly, oral anticoagulation is recommended for patients with high risk of stroke. However, it is widely underused and problems of compliance are associated with serious risk of bleeding or inefficacity. In these patients with non valvular atrial fibrillation, percutaneous occlusion of the left atrial appendage might help to reduce the risk of thromboembolism.
Cardiac imaging play a crucial role at all stages of this procedure and trans-oesophageal echocardiography represents the current gold-standard for the assessment of the left atrial appendage. Cardiac imaging is mandatory to precisely determine the left atrial appendage size and anatomy in order to select the appropriate device size. Finally, real time three dimension echocardiography is a powerful additional tool that improves the safety profile of the procedure. It allows accurate assessment of left atrial appendage anatomy, suitability for device implantation, continuous visualization of all intracardiac devices and catheters during the procedure, and clear delineation of device positioning in the left atrial appendage.
Credits: Sébastien Marchandise MD; Joëlle Kefer MD, PhD; Jean-Benoît le Polain de Waroux MD, PhD; Christophe Scavée MD; Jean-Louis Vanoverschelde MD, PhD