Use of FEops artificial intelligence enabled technology for preprocedural planning of left atrial appendage occlusion with Amulet Amplatzer device

Pre-procedural planning to guide structural heart interventions is often demanding and requires experience in cardiac imaging. Left atrial appendage (LAA) morphology is often complex [1] and variable. Transesophageal echocardiography (TEE) alone may not always be optimal to size the device adequately. Even experienced echocardiographers in certain conditions may sometimes have difficulty with proper sizing of the devices. Compared to TEE, computed tomography (CT) results in larger LAA orifice measurements, improves odds of predicting correct device size, and reduces fluoroscopy time in patients undergoing LAA occlusion [2]. Application of 3D printing, computational modeling, and ultimately incorporation of artificial intelligence are changing the landscape of today’s cardiac interventions [3].
Here we present 5 cases of LAA occlusion with additional use of artificial intelligence (AI) enabled technology FEops performed in the First Department of Cardiology in Katowice.

Case reports

Case 1

An 84-year-old man with persistent atrial fibrillation (CHA2DS2-VASc 6 points, HAS-BLED 4 points) was admitted for implantation of a left atrial occluder because of recurrent intestinal bleeding. Transthoracic echocardiography (TTE) revealed an enlarged left atrium with moderate valvular dysfunctions. In CT thrombus was excluded. Planning with FEops revealed a 2-lobed appendage with a very short but adequate landing zone (Figure 1). The AI simulated devices were the Amulet 22 mm, 25 mm, 28 mm, and 31 mm. According to our opinion and review of delivered simulations, taking into consideration frame deformation and the gap between the device and the wall of the appendage we chose a 25 mm device with high confidence for implantation. The stability was confirmed with a tug test. Proper placement of the device was confirmed in TTE on the next day, and in 2 months follow-up TEE. No complications were observed.

Case 2

A 74-year-old woman with persistent atrial fibrillation (CHA2DS2-VASc 5 points, HAS-BLED 4 points) was admitted for implantation of a left atrial occluder because of recurrent persistent anemia without apparent cause despite diagnostic tests, and intolerance of NOACS. Transthoracic echocardiography (TTE) revealed an enlarged left and right atrium without other apparent abnormalities. In CT thrombus was excluded, and LAA type 2C was observed with a very high degree of trabeculations. The simulated devices were Amulet 20,...


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