Preprocedural and Postprocedural CT Imaging Can Identify Patients at Risk for Complications After LAA Occlusion

BACKGROUND: Left atrial appendage occlusion (LAAO) is an established alternative to long-term anticoagulation in patients with atrial fibrillation. Predicting successful LAAO device implantation with preplanning imaging studies, including cardiac computed tomography (CCT), remains a challenge. OBJECTIVES: The purpose of this study was to determine whether specific preprocedural and postprocedural CCT measurements are associated with successful LAAO implantation and can predict early postimplant complications. METHODS: This was a single-center retrospective study including 165 patients who underwent LAAO with Watchman FLX between November 2022 and January 2025 and had both preimplant and postimplant CCT. Adverse events including peri-device leak, device-related thrombus, or cerebrovascular events (transient ischemic attack/stroke) within 90 days were followed. RESULTS: ; P < 0.001). CONCLUSIONS: Smaller LAA ostial dimensions and greater device compression (postimplant area change) on CCT were associated with fewer complications post-LAAO. Favorable preimplant LAA ostial morphology seems to be oval shaped and of smaller size. These characteristics could be helpful in predicting better postimplant outcomes.