Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging?

Afzal, Shazia; Piayda, Kerstin; Hellhammer, Katharina; Veulemans, Verena; Wolff, Georg; Heidari, Hadi; Stüwe, Dominique; Kanschik, Dominika; Polzin, Amin; Kelm, Malte; Zeus, Tobias

doi:10.1080/00015385.2020.1870193

Cited by 5 publications

(9 citation statements)

References 27 publications

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“…Several papers state that FI contributes to lowering total procedure time and amount of contrast medium used. In terms of time our data are comparable with other research, but in our procedures considerably less contrast was used [ 5 , 17 ]. Minimizing usage of contrast medium can be beneficial to patients suffering from renal failure who need LAAO.…”

Section: Discussionsupporting

confidence: 87%

“…Growing experience with fusion imaging confirms that it is a safe procedure in terms of mortality [ 18 ] and adverse effects [ 5 , 17 ]. Considering adverse effects supports FI to be a safe and effective method.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of fusion imaging (FI) has emerged as a pivotal strategy, unifying transesophageal echocardiography (TEE) and fluoroscopy into a singular, synergistic toolset. This dynamic synergy empowers clinicians with real-time, multi-dimensional insights, amalgamating the exquisite anatomical detail of TEE with the fluoroscopic visualization of catheter movement and device deployment [ 5 ]. By fusing these complementary modalities, operators gain a comprehensive understanding of cardiac anatomy, device positioning, and procedural progress, thereby ushering in a new era of enhanced patient outcomes and procedural excellence.…”

Section: Introductionmentioning

confidence: 99%

“…However, the imaging of heart muscle is severely limited by the amount of contrast medium possible to use [ 3 ]. TEE can accurately show the heart, but catheters and other devices are poorly visible [ 5 ]. Combining the two images from two displays is crucial for the outcome of the procedure yet involves great experience and effort from the interventionalist.…”

Section: Introductionmentioning

confidence: 99%

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Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Burysz,

Batko,

Malec-Litwinowicz

et al. 2024

kitp

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Introduction Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game-changer in transcatheter interventions. Aim This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions. Material and methods We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months. Results A cohort of 83 patients (mean age: 72.1 ±8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 ±34.3 min, contrast medium usage averaged 33.7 ±22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 ±3.4 days. Adverse effects were rare, including minimal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates. Conclusions This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Burysz,

Batko,

Malec-Litwinowicz

et al. 2024

kitp

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show abstract

“…Thus, guidance and navigation of catheters or devices while performing procedures can be facilitated [ 16 ]. We recently demonstrated the procedural advantages of FI for LAAC [ 17 ]: It reduces the procedure time, the time to transseptal puncture, and the periprocedural amount of contrast agent. Data about the impact of real-time echocardiography-fluoroscopy fusion imaging (FI) on the interventionalist’s learning curve during LAAC are lacking.…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic-Fluoroscopic Fusion Imaging Improves Interventionalists’ Learning Curve for Percutaneous Left Atrial Appendage Closure—Initial, Single-Center, Retrospective Observations

Kanschik,

Heidari,

Klein

et al. 2024

JCDD

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Due to the complex and variable anatomy of the left atrial appendage, percutaneous left atrial appendage closure (LAAC) can be challenging. In this study, we investigated the impact of fusion imaging (FI) on the LAAC learning curve of two interventionalists. The first interventionalist (IC 1) was initially trained without FI and continued his training with FI. The second interventionalist (IC 2) performed all procedures with FI. We compared the first 36 procedures without FI of IC 1 (group 1) with his next 36 interventions with FI (group 2). Furthermore, group 1 was compared to 36 procedures of IC 2 who directly started his training with FI (group 3). Group 1 demonstrated that the learning curve without FI has a flat course with weak correlations for fluoroscopy time, contrast volume, and procedure time, but not for dose area product. Group 2 with FI showed improvement with a steep course and strong correlations for all four parameters. In group 3, we also saw a steep progression with strong correlations. Furthermore, the mean measurements of the parameters in the groups with FI decreased significantly as an indicator of procedural efficacy. We demonstrated that FI may improve the learning curve of experienced and non-experienced ICs.

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Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography–Fluoroscopy Fusion Imaging

Maresch

Chacon

Markin

2022

Journal of Cardiothoracic and Vascular Anesthesia

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Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging?

Cited by 5 publications

References 27 publications

Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Echocardiographic-Fluoroscopic Fusion Imaging Improves Interventionalists’ Learning Curve for Percutaneous Left Atrial Appendage Closure—Initial, Single-Center, Retrospective Observations

Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography–Fluoroscopy Fusion Imaging

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