Multimodality imaging in evaluating and guiding percutaneous left atrial appendage occlusion

Authors

Renuka Jain, Advocate Health - MidwestFollow
Priscilla Wessly, Advocate Health - MidwestFollow
Muhamed Saric, Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016 USA.
Karl Richardson, Department of Cardiovascular Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157 USA.
Enrique Garcia-Sayan, Section of Cardiology, Department of Medicine, Texas Heart Institute at Baylor College of Medicine, 6624 Fannin St., Suite 2480, Houston, TX 77030 USA.
Karima Addetia, Section of Cardiology, University of Chicago Heart & Vascular Center, 5842 S. Maryland Ave., Chicago, IL 60637 USA.
Lauren Howard, Advocate Health - MidwestFollow
Thomas Finn, Advocate Health - Midwest
Nishath Quader, Division of Cardiovascular Medicine, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA.

Recommended Citation

Jain R, Wessly P, Saric M, et al. Multimodality Imaging in Evaluating and Guiding Percutaneous Left Atrial Appendage Occlusion. J Am Soc Echocardiogr. Published online July 25, 2025. doi:10.1016/j.echo.2025.07.009

Affiliations

Aurora Sinai/Aurora St. Luke's Medical Centers

Abstract

Left atrial appendage occlusion (LAAO) has emerged as an important intervention for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are unable to tolerate long-term anticoagulation. The development of advanced imaging technologies and techniques, such as 3D echocardiography with multiplanar reconstruction (MPR), multidetector computed tomography (MDCT), 3D intracardiac echocardiography (ICE), 3D printing, and simulation, has revolutionized pre-procedural planning, intra-procedural guidance, and post-procedural surveillance, ensuring improved precision and outcomes. Transesophageal echocardiography (TEE) remains a foundational imaging modality for assessing LAA morphology, excluding thrombi, and obtaining accurate measurements for device sizing. Recent advances in 3D TEE and MPR techniques enable enhanced visualization of complex LAA anatomies, improving device selection and procedural planning. Multidetector computed tomography has a growing role, offering high-resolution 3D reconstructions for detailed anatomical assessment. Additionally, its applications in 3D printing and virtual device simulation provide patient-specific insights, facilitating optimal device sizing and improving procedural efficiency. Intra-procedurally, 3D ICE has gained traction as a valuable alternative to TEE. With its real-time imaging capabilities and high spatial resolution, 3D ICE allows precise guidance during transseptal puncture and device deployment while reducing the need for general anesthesia. Post-procedurally, both TEE and MDCT play critical roles in assessing device stability and identifying complications such as device-related thrombus and peri-device leak. This review highlights the evolving role of multimodality imaging in LAAO, including innovations such as 3D ICE, 3D printing, and simulation. It also reviews recent literature to establish state-of-the-art imaging practices, providing a comprehensive discussion of imaging applications across pre-, intra-, and post-procedural phases to optimize outcomes and minimize complications in LAAO.

Type

Article

PubMed ID

40716581