The additive value of preprocedural cardiac computed tomography angiography (CCTA) planning in percutaneous left atrial appendage occlusion: a systematic review and meta-analysis

Cardiac computed tomography angiography (CCTA) is increasingly used to guide left atrial appendage occlusion (LAAO) by providing a detailed anatomical assessment. However, its incremental value over conventional planning methods, such as transesophageal echocardiography or fluoroscopy, remains uncertain. This study evaluated the additive value of CCTA-guided planning in percutaneous LAAO. A systematic review and meta-analysis conducted using PubMed, Embase, CENTRAL, Scopus, and Web of Science, up to September 2024 (updated in July 2025). Dichotomous outcomes were pooled as risk ratios (RR), while continuous outcomes were pooled as mean differences (MD) along the corresponding 95% confidence intervals (CI). PROSPERO ID: CRD42024600363. Six studies comprising 978 patients with follow-up periods of up to 90 days were included. The CCTA-guided group had significant higher device implantation success [RR: 1.06; 95% CI (1.01, 1.11), P = 0.028], a lower device resizing [RR: 0.42; 95% CI (0.26, 0.66), P = 0.0002], and a lower procedure time [MD: -13.29 min; 95% CI (-23.72, -2.86), P = 0.01]. There was no significant difference between the two groups in device-related embolization [P = 0.38], peri-device leakage [P = 0.16], radiation dose [P = 0.84], and contrast utilization [P = 0.96]. Adding CCTA to preoperative planning for LAAO as a complementary modality can increase implantation success rate, improve device selection accuracy, and shorten procedure time without increasing adverse events or contrast use with substantial heterogeneity and divergent subgroups. However, limited follow-up restricts long-term safety conclusions. Further large-scale, long-term randomized trials are needed to validate these findings.