Usability and accuracy of a cloud-based sizing software for left atrial appendage closure

To the Editor, The complex and highly variable 3D anatomy of the left atrial appendage (LAA) makes it challenging for planning and device sizing for left atrial appendage closure (LAAC).1 Echocardiography and multi-slice computed tomography (CT) are widely used imaging modalities for this purpose. 3Mensio Structural Heart (Pie Medical Imaging BV, The Netherlands) is the most widely used software for CT evaluation of LAA providing automatic segmentation of the heart. TribusConnect (TribusMed Beheer BV, The Netherlands) is a novel cloud-based Digital Imaging and Communications in Medicine (DICOM) viewer that can also be used to securely access, review, interpret, manipulate, measure and visualize images with automatic cardiac segmentation for LAA evaluation. Furthermore, TribusConnect allows for manual correction or adjustment of the automatically generated measurements or segmentation which could be crucial for centers with varying image quality, or challenging anatomies. This study aimed to investigate the feasibility, accuracy and reproducibility of evaluating the LAA in TribusConnect compared with the 3Mensio for preprocedural planning of LAAC. Seventeen patients who underwent LAAC at Hospital Clínico Universitario de Valladolid (Valladolid, Spain) were included in our study. A total of 52.9% (9 patients) of these patients underwent LAAC by Amplatzer Amulet (Abbott, United States) while 17.6% (3 patients)...