A retrospective analysis of the NCDR LAAO registry sheds light on the rate of utilization of preprocedure computed tomography (CT)/magnetic resonance imaging (MRI) in left atrial appendage occlusion (LAAO) procedures. The findings reveal a concerning underutilization of preprocedure imaging, with only one in five procedures incorporating this crucial step.

Patients who underwent preprocedural anatomic assessment of the left atrial appendage (LAA) experienced slightly better device and procedural success rates compared to those who did not undergo preprocedure imaging. Preprocedure imaging offers the advantage of understanding LAA anatomy, ruling out thrombus, and enabling the identification of cases that are unsuitable for closure. The study highlights the importance of integrating preprocedure imaging to optimize outcomes.

While preprocedure imaging has demonstrated associations with improved success rates, it comes with limitations and considerations. The study notes increased utilization and contrast exposure as potential drawbacks. However, it emphasizes that preprocedure imaging did not significantly impact major adverse events (MAE), highlighting the importance of assessing the net clinical benefit and cost-effectiveness of this imaging modality.

The Way Forward: Implications for Clinical Practice and Research

The retrospective analysis underscores the need for further research to evaluate the cost-effectiveness and net clinical benefit of preprocedure imaging prior to LAAO. Randomized, controlled studies are warranted to assess the long-term impact of preprocedure imaging on patient outcomes, healthcare resource utilization, and the overall safety and efficacy of LAAO procedures. These investigations will provide valuable insights for guiding clinical practice and optimizing patient care.

By integrating preprocedure imaging into LAAO procedures, clinicians gain valuable insights into appendage anatomy and can identify potential obstacles that may arise during the procedure. This information empowers informed decision-making, allowing for the customization of interventions and the selection of patients who are most likely to benefit from LAAO. The study emphasizes the importance of considering preprocedure imaging as an essential component of comprehensive LAAO strategies.

The findings from this retrospective analysis provide a foundation for ongoing collaboration between clinicians, researchers, and industry experts. By leveraging the insights gained from preprocedure imaging, innovative approaches can be developed to optimize the safety and success of LAAO procedures. Continued exploration and refinement of imaging techniques and protocols will drive advancements in the field and ultimately improve patient outcomes.