Role of Cardiac Imaging for Catheter-based Left Atrial Appendage Closure.

Thromboembolic stroke is the most serious complication in patients suffering from Atrial Fibrillation. Atrial thrombi have a predilection to form in the left atrial appendage. Accordingly, oral anticoagulation is recommended for patients with high risk of stroke. However, it is widely underused and problems of compliance are associated with serious risk of bleeding or inefficacy. In these patients with non-valvular atrial fibrillation, percutaneous occlusion of the left atrial appendage might help to reduce the risk of thromboembolism. Cardiac imaging plays a crucial role at all stages of this procedure and trans-esophageal echocardiography represents the current gold-standard for the assessment of the left atrial appendage. Cardiac imaging is mandatory to precisely determine the left atrial appendage anatomy and to select the appropriate size for the device. Finally, real time three-dimension echocardiography is a powerful additional tool that improves the safety profile of the procedure. 3D-transoesophageal echocardiography allows for the accurate assessment of left atrial appendage anatomy and helps determine if it's suitable for device implantation. Finally, it also allows for continuous visualization of all intracardiac devices and catheters during the procedure, and the clear delineation of device positioning in the left atrial appendage.