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Background Left atrial appendage occlusion (LAAO) with Watchman device traditionally relies on accurate left atrial appendage ostium diameter measurement by 2D or 3D transesophageal echocardiogram (TEE). Alternate methods of ostium measurement including area-derived diameter and perimeter-derived diameter using cardiac computed tomography (CT) have been proposed. Methods We performed a retrospective analysis of 92 patients with atrial fibrillation (Afib) who underwent LAAO with WATCHMAN implantation with pre-procedural TEE and CT between May 2015 and December 2018. LAA characteristics including ostial or landing zone perimeter, minimum and maximum diameters were acquired utilizing 3mensio Structural Heart Imaging Program. Proposed device size was estimated utilizing ostium perimeter by CT and compared to the current standard utilizing ostium diameter by 2D-TEE. Both measurements were then compared to actual final device size that satisfying release criteria. Results CT had a very high correlation with the actual implanted device size (Pearson coefficient r=0.94, p&amp;lt;0.001), while TEE based sizing had a lower correlation (Pearson coefficient r=0.66, p&amp;lt;0.001). CT predicted size had a significantly higher agreement compared to standard TEE based sizing (93.4% vs 47.8%), and higher interrater agreement (Cohen's kappa = 0.91 vs Cohen's kappa = 0.32, p&amp;lt;0.001, p&amp;lt;0.001 respectively). Bland-Altman analysis also showed better correlation with CT-based sizing. Procedural complications were 0, and 0 patients had a leak recorded at 45-days post implant. Conclusion CCT LAA perimeter sizing is superior to the current standard TEE based Watchman sizing. Larger, multi-center studies may be necessary to further validate results. Funding Acknowledgement Type of funding sources: None. 3mensio after CT upload

Left atrial appendage perimeter ostium evaluation by cardiac CT utilizing 3mensio technology for watchman implantation