Clinical Impact of Preprocedural CT-Based 3D Computational Simulation of Left Atrial Appendage Occlusion with Amulet

Figure 1

Illustrative case of a 70-year-old man with paroxysmal atrial fibrillation, CHADS-VASc score of 4, HAS-BLED score of 4, and previous intracranial haemorrhage scheduled for LAAO. Measurements of the os and landing zone, respectively, by 3D TEE were 23 × 31 mm and 19 × 22 mm, and those by CT were 22 × 30 mm and 19 × 22 (18.6 × 21.9 mm, left panel). Standard of care assessment had chosen for a 25 Amulet, with team’s confidence 6 out of 10. FEops 3D rendering volume showed a chicken wing morphology (middle panel). Computation simulation of a 22 Amulet revealed limited compression (5.0 to 5.9%) and apposition both in proximal and distal positions, while a 25 Amulet had a better compression (12.6 to 14.4%) and apposition (see colour code, green 0 mm distance between device and appendage and red 2 mm) with good sealing of the os. A 25 Amulet with distal position was chosen with confidence 8 out of 10. Postimplantation images showed perfect position and sealing (right panel).