Volume 5, Issue 4, December 2019, Page: 38-44
Diagnose the Size of Left Atrial Appendage for Watchman Device
Hamidreza Khezri, Electronic Engineering Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Mojtaba Farzaneh, Electronic Engineering Department, Hakim Sabzevari University, Sabzevar, Iran
Received: Sep. 26, 2019;       Accepted: Oct. 14, 2019;       Published: Oct. 28, 2019
DOI: 10.11648/j.bs.20190504.11      View  527      Downloads  114
Nowadays Atrial Fibrillation (AFib) has been highly epidemic that is a heart condition causes the heart in an irregular rhythm and can increase the risk of stroke. The Left Atrial Appendage (LAA) which is a part of the heart is the main source of thrombosis in patients with AFib. Since AFib patients are at risk of developing clots in LAA, it is, therefore, necessary to detect the LAA anatomy and closure of LAA to prevent stroke. For some reason, such as the presence of different muscles in the heart and the irregular anatomy of LAA, detecting and determining the exact size of the LAA is difficult. In this paper, we present a fully automatic approach to diagnose the LAA and measure its size based on the inlet orifice and the depth of the LAA primary lobe for the implant by the WATCHMAN device. These processes utilize images that were taken by echocardiography (Echo) from the heart of patients and analyses at high speed with precision, and used the standard table provided by the manufacturer (WATCHMAN) and Neural Network (NN) to determine the accuracy the appropriate size of LAA for left atrial appendage closure (LAAC).
Atrial Fibrillation (AFib), Left Atrial Appendage Closure (LAAC), WATCHMAN Device, Stroke, Echocardiography (Echo)
To cite this article
Hamidreza Khezri, Mojtaba Farzaneh, Diagnose the Size of Left Atrial Appendage for Watchman Device, Biomedical Sciences. Vol. 5, No. 4, 2019, pp. 38-44. doi: 10.11648/j.bs.20190504.11
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
M. Taina, R. Vanninen, P. Sipola, A. Muuronen, M. Hedman. Cardiac CT differentiates left atrial appendage thrombi from circulatory stasis in acute stroke patients, In Vivo 30 (5) (2016) 671–676.
M. Yamamoto, Y. Seo, N. Kawamatsu, K. Sato, A. Sugano, T. Machino-Ohtsuka, R. Kawamura, H. Nakajima, M. Igarashi, Y. Sekiguchi, Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation, Circulation Cardiovascular Imaging 7 (2) (2014) 337–343.
N. M. Alsaady, O. A. Obel, A. J. Camm, Left atrial appendage: structure, function, and role in thromboembolism, Heart 82 (5) (1999) 547–554.
Y. Zheng, D. Yang, M. John, D. Comaniciu, Multi-part modeling and segmentation of left atrium in C-arm CT for image-guided ablation of atrial fibrillation, IEEE Trans. Med. Imag. 33 (2) (2014) 318–331.
P. Grasland-Mongrain, J. Peters, O. Ecabert, Combination of shape-constrained and inflation deformable models with application to the segmentation of the left atrial appendage, in: IEEE International Symposium on Biomedical Imaging: from Nano to Macro, 14-17 April, 2010, pp. 428–431. Rotterdam, the Netherlands.
T. Tabata, T. Oki, A. Iuchi, H. Yamada, K. Manabe, K. Fukuda, M. Abe, N. Fukuda, S. Ito, Evaluation of left atrial appendage function by measurement of changes in flow velocity patterns after electrical cardioversion in patients with isolated atrial fibrillation, Am. J. Cardiol. 79 (5) (1997) 615–620.
Hussain SK, Malhotra R, DiMarco JP. Left Atrial Appendage Devices for Stroke Prevention in Atrial Fibrillation. J Cardiovasc Transl Res. 2014; 7: 458–64.
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285: 2864–70.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22: 983–8.
Gómez-Outes A, Terleira-Fernández AI, Calvo-Rojas G, Suárez-Gea ML, Vargas-Castrillón E. Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups. Thrombosis. 2013; 2013: 640723.
A. Alissa, Y. Inoue, J. Cammin, Q. Tang, S. Nazarian, H. Calkins, E. K. Fishman, K. Taguchi, and H. Ashikaga. Regional function analysis of left atrial appendage using motion estimation CT and risk of stroke in patients with atrial fibrillation, European Journal of Echocardiography, vol. 17, no. 7, pp. 788–796, 2016.
J. P. Piccini and L. Fauchier. Rhythm control in atrial fibrillation, The Lancet, vol. 388, no. 10046, pp. 829–840, 2016.
V. Y. Reddy, H. Sievert, J. L. Halperin, S. K. Doshi, M. Buchbinder, P. Neuzil, K. C. Huber, B. Whisenant, S. Kar, V. Swarup et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation a randomized clinical trial, JAMA, vol. 312, no. 19, pp. 1988–1998, 2014.
R. Weerasooriya, P. Khairy, J. Litalien, L. Macle, M. Hocini, F. Sacher, N. Lellouche, S. Knecht, M. Wright, I. Nault et al. Catheter ablation for atrial fibrillation, Journal of the American College of Cardiology, vol. 57, no. 2, pp. 160–166, 2011.
G. Lee, P. Sanders, and J. M. Kalman. Catheter ablation of atrial arrhythmias: state of the art, The Lancet, vol. 380, no. 9852, pp. 1509–1519, 2012.
D. Feng, W. D. Edwards, J. K. Oh, K. Chandrasekaran, M. Grogan, M. W. Martinez, I. I. Syed, D. A. Hughes, J. A. Lust, A. S. Jaffe et al. Intracardiac thrombosis and embolism in patients with cardiac amyloidosis, Circulation, vol. 116, no. 21, pp. 2420–2426, 2007.
Benjamin EJ, Blaha MJ, Chiuve SE, et al. HeartDisease and Stroke Statistics-2017 update: areport from the American Heart Association.Circulation 2017; 135: e146–603.
Kong B, Liu Y, Huang H, Jiang H, Huang C. Left atrial appendage closure for thromboembolism prevention in patients with atrial fibrillation: advances and perspectives. J Thorac Dis. 2015; 7: 199–203.
K. Fukushima, N. Fukushima, K. Kato, K. Ejima, H. Sato, K. Fukushima, C. Saito, K. Hayashi, K. Arai, T. Manaka et al. Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation, European Journal of Echocardiography, vol. 17, no. 1, pp. 59–66, 2016.
H. Oe, Y. Ohno, T. Yamanaka, N. Watanabe, and H. Ito. Biatrial appendage thrombi in a heart failure patient with sinus rhythm detailed assessment by real-time 3-dimensional transesophageal echocardiography, Circulation, vol. 133, no. 1, pp. e1–e4, 2016.
Su P, McCarthy KP, Ho SY. Occluding the left atrial appendage: anatomical considerations. Heart 2008; 94: 1166–70.
Victor S, Nayak VM. Aneurysm of the left atrial appendage. Tex Heart Inst J 2001; 28: 111–8.
Shirani J, Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol 2000; 9: 95–101.
Reddy VY, Möbius-Winkler S, Miller MA, Neuzil P, Schuler G, Wiebe J, Sick P, Sievert H. Leftatrial appendageclosure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study with Watchman Left Atrial Appendage Closure Technology) J Am Coll Cardiol. 2013; 61: 2551– 6.
Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S. Safety of percutaneous left atrial appendage closure: results from the watchman left atrial appendage system for embolic protection in patients with AF (PROTECT AF) clinical trial and the continued access registry. Circulation. 2011; 123: 417–24.
Fountain RB, Holmes DR, Chandrasekaran K, Packer D, Asirvatham S, Van Tassel R, Turi Z. The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial. Am Heart J. 2006; 151: 956–61.
Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber K, Halperin JL, Holmes D PROTECT AF Investigators. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-Year Followup of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial. Circulation. 2013; 127: 720–9.
Park JW, Bethencourt A, Sievert H, Santoro G, Meier B, Walsh K, Lopez-Minquez JR, Meerkin D, Valdés M, Ormerod O, Leithäuser B. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv. 2011; 77: 700–6.
Sven Möbius-Winkler, Marcus Sandri, Norman Mangner, Phillip Lurz, Ingo Dähnert, and Gerhard Schuler. The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation. 2012. doi: 10.3791/3671.
O. Ecabert, J. Peters, H. Schramm, C. Lorenz, J. von Berg, M. J. Walker, M. Vembar, M. E. Olszewski, K. Subramanyan, G. Lavi et al., “Automatic model-based segmentation of the heart in CT images,” IEEE Transactions on Medical Imaging, vol. 27, no. 9, pp. 1189–1201, 2008.
Haemers P, Hamdi H, Guedj K, et al. Atrial fibrillation is associated with thefibroticremodelling of adipose tissue in the subepicardiumof human and sheep atria. Eur Heart J 2017; 38:53–61.
P. Grasland-Mongrain, “Segmentation of the left atrial appendage from 3D images”. Master Thesis. ENS Cachan. 2009.
Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised noninferiority trial. Lancet. 2009; 374: 534–42.
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