Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: A pilot study

Abstract

Background Left atrial appendage occlusion (LAAO) is usually performed via the guidance of procedural transesophageal echocardiography (TEE) companied by general anesthesia (GA). Objective To investigate the feasibility and safety of LAAO guided by procedural fluoroscopy only. Methods The patients eligible for LAAO were enrolled into the current study and received implantation of either Watchman device or LAmbre device. The procedure was carried out with procedural fluoroscopy only and no companied GA; the position, shape, and leakage of the device were assessed by contrast angiography. TEE was performed after 3‐month follow‐up to evaluate the thrombosis, and leakage of device. Results Ninety‐seven patients with atrial fibrillation (AF) with either Watchman device (n = 49) or LAmbre device (n = 48) were consecutively enrolled. Watchman device group was of lower CHA2DS2‐VASc and HAS‐BLED scores compared with LAmbre device groups (p < .05); the two groups had similar distributions of other baseline characteristics (p > .05), including procedural success rate (98.0% vs. 97.9%), mean procedure time, mean fluoroscopy time, total radiation dose, contrast medium dose, percentage of peri‐device leakage. Pericardial effusions requiring intervention occurred in two of the Watchman group. TEE follow‐up found no patient with residual leakage ≥5 mm at 3 months and no device related thrombosis (DRT). During the 22.0 ± 11.1 months follow‐up, two patients experienced ischemic stroke. Conclusions LAAO with the procedural imaging of fluoroscopy only exhibited the promising results of efficacy and safety. A prospective randomized multicenter study would be required to verify the observations in this study.

Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes

“…Although there have been no articles on the safety and feasibility of DSA alone to guide the combined procedure, the procedure time, fluoroscopy time, total radiation dose, and percentage of fluoroscopic PDL in the LAAO of our study is similar to the previous reports of the LAAO under procedural DSA guidance only 16,19,23 . In the present study, compared with the TEE cohort, the procedure time of the DSA cohort was significantly reduced and there was no significant difference in the complication rate and fluoroscopy time.…”

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

“…The safety and feasibility of MLAAO have previously been evaluated 4–7 . In our study, we found no statistically significant difference in the rate of successful device implantation between the MLAAO group and the SLAAO group.…”

“…Emerging evidence suggests that LAAO guided by fluoroscopy guidance only (minimal LAAO [MLAAO]) is also safe and reliable. [4][5][6][7] The aim of this study was to summarize the preliminary results of MLAAO in patients with NVAF under the guidance of fluoroscopy at our center, assess the feasibility and safety of MLAAO and explore its potential benefits.…”

The safety and efficacy of the LAmbre left atrial appendage closure device in atrial fibrillation: a systematic review and meta-analysis

“…Therefore, the CHA2DS2-VASc score in the LAmbre group was higher than that in other LAAC group(5.0±1.5 vs 4.1±1.8), which was confirmed by the result. In other studies, 26,28 (Litwinowicz et al 4.0 +-1.1 vs 3.9 +-1.0, Chen et.al. 4.1 +-1.0 vs 3.9 +-1.1, Wang et al 2.8 +-1.0 vs 2.3 +-0.9 ).…”

“…Three hundred and nine articles were obtained by online and manual searches. After removing duplicates, screening titles and abstracts, four independent trials [25][26][27][28] contained data for the LAmbre occluder versus other LAAC devices were selected that included 607 patients (142 randomized to the LAmbre occluder and 465 to other LAAC devices). (Figure 1) (as seen in the flow chart).…”