The following are key points to remember from these expert recommendations about cardiac computed tomography (CT) for planning transcatheter left atrial appendage occlusion (LAAO):

1. LAAO has been demonstrated to be effective and safe for the prevention of stroke in selected patients with atrial fibrillation. This represents an alternative to anticoagulation in some patients.
2. The LAA has a highly variable size and shape, and cardiac imaging is critical to determine appropriate patient selection and device sizing.
3. While transesophageal echocardiography is the current standard for preprocedural planning prior to LAAO, CT is a promising alternative that may improve device size selection due to its acquisition of a three-dimensional dataset with high spatial resolution. This consensus document proposes a standardized protocol for CT acquisition and interpretation prior to LAAO procedures.
4. A 64-slice CT platform may be adequate for imaging, although newer platforms have advantages that can improve image quality with low radiation doses.
5. Rate control medications are typically not needed unless patients have very high heart rates, and nitroglycerin is not indicated for these studies.
6. As the LAA may not fill adequately with contrast during the main acquisition, it can have an appearance that suggests possible thrombus. The addition of a second delayed acquisition (e.g., 60 seconds after peak contrast opacification) on CT can result in a consistently high sensitivity (100%) and specificity (98-100%) to detect LAA thrombus.
7. Many software packages are available that can provide imaging post-processing. The manuscript recommends that LAAO operators have experience with these and understand how these studies are analyzed and interpreted.
8. The authors recommend standard views and three-dimensional reconstructions that can be used to determine the feasibility and sizing for LAAO.
9. Future techniques that may further improve device selection and sizing include three-dimensional printing, computational modeling, and CT/fluoroscopy fusion imaging.
10. CT has a potential to become the new gold standard for optimal planning of LAAO.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Noninvasive Imaging, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Cardiology Interventions, Diagnostic Imaging, Echocardiography, Transesophageal, Fluoroscopy, Heart Rate, Imaging, Three-Dimensional, Nitroglycerin, Radiation Dosage, Thrombosis, Tomography, Tomography, Emission-Computed

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