Author + information
- Received May 29, 2015
- Revision received July 14, 2015
- Accepted July 30, 2015
- Published online December 28, 2015.
- Ryan J. Spencer, MD,
- Peggy DeJong, MD,
- Peter Fahmy, MD,
- Mathieu Lempereur, MD,
- Michael Y.C. Tsang, MD,
- Kenneth G. Gin, MD,
- Pui K. Lee, MD,
- Parvathy Nair, MD,
- Teresa S.M. Tsang, MD,
- John Jue, MD and
- Jacqueline Saw, MD∗ ()
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ↵∗Reprint requests and correspondence:
Dr. Jacqueline Saw, Division of Cardiology, 2775 Laurel Street, Level 9, Vancouver General Hospital, Vancouver, British Columbia V5Z1M9, Canada.
Objectives This study sought to determine whether volume loading alters the left atrial appendage (LAA) dimensions in patients undergoing percutaneous LAA closure.
Background Percutaneous LAA closure is increasingly performed in patients with atrial fibrillation and contraindications to anticoagulation, to lower their stroke and systemic embolism risk. The safety and efficacy of LAA closure relies on accurate device sizing, which necessitates accurate measurement of LAA dimensions. LAA size may change with volume status, and because patients are fasting for these procedures, intraprocedural measurements may not be representative of true LAA size.
Methods Thirty-one consecutive patients undergoing percutaneous LAA closure who received volume loading during the procedure were included in this study. After an overnight fast and induction of general anesthesia, patients had their LAA dimensions (orifice and depth) measured by transesophageal echocardiography before and after 500 to 1,000 ml of intravenous normal saline, aiming for a left atrial pressure >12 mm Hg.
Results Successful implantation of LAA closure device was achieved in all patients. The average orifice size of the LAA at baseline was 20.5 mm at 90°, and 22.5 mm at 135°. Following volume loading, the average orifice size of the LAA increased to 22.5 mm at 90°, and 23.5 mm at 135°. The average increase in orifice was 1.9 mm (p < 0.0001). The depth of the LAA also increased by an average of 2.5 mm after volume loading (p < 0.0001).
Conclusions Intraprocedural volume loading with saline increased the LAA orifice and depth dimensions during LAA closure. Operators should consider optimizing the left atrial pressure with volume loading before final device sizing.
Dr. Gin is on the advisory boards of Bayer, Pfizer, and Boehringer Ingelheim. Dr. Saw has received unrestricted research grant support from the Canadian Institutes of Health Research, University of British Columbia Division of Cardiology, AstraZeneca, Abbott Vascular, St. Jude Medical, Boston Scientific, and Servier; speaker honoraria from AstraZeneca, St. Jude Medical, Boston Scientific, Bayer, and Sunovion; consultancy and advisory board honoraria from AstraZeneca, St. Jude Medical, Boston Scientific, and Abbott Vascular; and proctorship honoraria from St. Jude Medical and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 29, 2015.
- Revision received July 14, 2015.
- Accepted July 30, 2015.
- 2015 American College of Cardiology Foundation