Variations in Procedural Planning Modalities
Due to the variable anatomy of any given patient’s LAA, pre-procedural planning is imperative to select the correct device size and ensure the feasibility and safety of implantation. Initially, device sizing and procedural guidance were conducted with trans-esophageal echocardiography (TEE) [4]. However, TEE during the procedure often requires general anesthesia necessitating overnight observation, and has been shown to undersize the estimated LAA orifice, leading to incorrect device size selection [5]. These pitfalls led to the advent of computed tomography (CT) for procedural planning and device selection [6]. Given its cross-sectional nature, CT appears to provide a better estimation of the diameter of the LAA orifice and the general area, allowing for careful device selection [7]. However, CT also has drawbacks, mainly the need for iodinated contrast, which limits its use in patients with chronic renal disease.