Cardiac CT Roadmap for Left Atrial Appendage Occlusion: From Planning to Strategy to Follow-Up.

Cardiac computed tomography (CCT) has emerged as a central imaging modality in the workflow for left atrial appendage occlusion (LAAO), as accurate anatomical assessment is vital for successful intervention. CCT provides superior three-dimensional (3D) anatomical detail and isotropic spatial resolution compared to traditional trans-esophageal echocardiography, enabling precise pre-procedural planning, device sizing, and identification of optimal fluoroscopic projections. Furthermore, CCT serves as a highly accurate, non-invasive tool for detecting post-procedural complications such as peri-device leaks and device-related thrombosis. Beyond conventional imaging, CCT-derived datasets now facilitate advanced computational applications, including patient-specific 3D printing, computational fluid dynamics, and finite element modeling, to predict device-tissue interactions and post-implant hemodynamics. Additionally, artificial intelligence is increasingly integrated to automate segmentation and enhance risk stratification. This review provides a comprehensive overview of the expanding role of CCT in LAAO, highlighting its contribution to procedural optimization and the transition toward personalized, engineering-driven cardiac interventions.