Multimodality Imaging for Left Atrial Appendage Occlusion Devices

This review summarizes the current and evolving landscape of multimodality imaging for percutaneous endocardial left atrial appendage occlusion (LAAO) across three phases: preprocedural planning, periprocedural guidance, and postprocedural follow-up. Transesophageal echocardiography (TEE) remains the primary imaging modality to assess the left atrial appendage (LAA) in all three phases of clinical care surrounding LAAO, though many innovations have led to the rise of cardiac computed tomography (CCT) and intracardiac echocardiography (ICE) as powerful adjuncts and alternatives to TEE. Advances in CCT technology such as fusion imaging and three-dimensional (3D) modeling have contributed to the emergence of CCT as an alternative to TEE for preprocedural evaluation. Intraprocedurally, real-time 3D ICE offers similar real-time guidance to TEE with similar procedural efficacy while employing a simplified workflow that can reduce procedural times and staffing needs. Post-procedural assessment with TEE or CCT is essential for evaluating device stability and complications such as peridevice leak or device-related thrombus. Multimodality imaging of LAAO is a rapidly evolving field, and thoughtful integration of TEE, CCT, and ICE is critical to optimize LAAO outcomes and minimize procedural complications.