Optical coherence tomography to visualise the endothelialisation of left atrial appendage occluders

Occlusion of the left atrial appendage (LAA) by an LAA occluder (LAAO) has become an alternative treatment to oral anticoagulants for stroke prevention in patients with atrial fibrillation1. However, device-related thrombus might occur because of incomplete endothelialisation of the LAAO surface2. Current imaging techniques, such as transoesophageal echocardiography or computed tomography (CT), have limitations in detecting LAAO endothelialisation. Optical coherence tomography (OCT) has been widely used in coronary intervention procedures for the visualisation of plaque morphology, stent apposition and stent endothelialisation3. In the present study, we proposed a technique for evaluating LAAO endothelialisation using OCT images.

As this was a first-in-human procedure, we proposed performing it in conjunction with pulmonary vein isolation in eligible patients with a pre-existing LAAO. Pulmonary vein isolation was performed first using the three-dimensional (3D)-mapping system and a steerable sheath, as in our previously reported methods45.

After transseptal puncture, we inserted a transseptal sheath through a percutaneous transvenous mitral valvuloplasty (PTMV) Inoue wire (Toray) to prevent the catheter tip damaging the left atrium (LA). As mentioned above, we performed PVI first,...