Cardiac CT angiography after percutaneous left atrial appendage closure: early versus delayed scanning after contrast administration

PURPOSE Cardiac computed tomography angiography (CCTA) is increasingly used for device surveillance after left atrial appendage closure (LAAC). While CT protocols with delayed scans are useful to diagnose thrombus in the LAA, an optimal protocol for post-procedural CCTA has not been established. Therefore, we assessed the role of delayed versus early scans for device surveillance. METHODS We retrospectively reviewed patients who underwent LAAC at Vancouver General Hospital who had follow-up CCTAs using standard (early) and delayed scans. Scans were performed on Toshiba 320-detector (Aquilion ONE). Image quality was interpreted by 2 independent observers for anatomy, LAA contrast patency, and device-related thrombus (DRT) using Vitrea-Workstation[TM]. A Likert scale of 1-5 was used (1= poor quality, 5= excellent) for assessment. RESULTS We included 27 consecutive LAAC patients (9 Amplatzer, 18 WATCHMAN) with mean age 76.0[+ or -]7.7 years, mean CHAD[S.sub.2] score 2.8[+ or -]1.3, CH[A.sub.2]D[S.sub.2]-VASc score 4.4[+ or -]1.6 and HAS-BLED score 3.4[+ or -]1.0. Subjective quality assessments by both reviewers favored early scans for assessment of anatomy (reviewer 1: 4.63[+ or -]0.63 [early] vs. 1.74[+ or -]0.71 [delayed]; reviewer 2: 4.63[+ or -]0.63 [early] vs. 1.89[+ or -]0.64 [delayed]) and DRT (reviewer 1: 4.78[+ or -]0.42 [early] vs. 3.11[+ or -]1.16 [delayed]; reviewer 2: 4.70[+ or -]0.47 [early] vs. 3.04[+ or -]1.29 [delayed]). Inter-rater variability showed good correlation between reviewers (intraclass correlation 0.61-0.95). Mean LAA/LA attenuation ratios were significantly different between scans, with larger mean percent reduction of contrast opacification from LA to LAA in the early scans (57.0[+ or -]36.6% reduction for early vs. 29.1[+ or -]30.8% for delayed; p < 0.001). CONCLUSION For CT device surveillance post-LAAC early phase imaging provides superior image quality objectively and subjectively compared with delayed scanning.