Minimal left atrial appendage occlusion guided by fluoroscopy alone achieved similar device implantation success compared to standard TEE guidance (p > 0.05), with shorter procedure times.
Cohort (n=249)
Does minimal LAAO under fluoroscopy guidance alone improve procedural efficiency and safety compared to standard TEE-guided LAAO in patients with NVAF?
Minimal LAAO guided by fluoroscopy alone without general anesthesia is feasible and safe, reducing procedure time and hospitalization duration compared to standard TEE-guided LAAO.
p-value: p=> 0.05
BACKGROUND: Left atrial appendage occlusion (LAAO) has been considered an alternative treatment to prevent embolic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it carries a risk of general anesthesia or esophageal injury if guided by transesophageal echocardiography (TEE). AIMS: We aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF. METHODS: A total of 249 consecutive patients with NVAF who underwent LAAO using the WATCHMAN device were divided into two groups: the Standard LAAO (SLAAO) group and the MLAAO group. Procedural characteristics and follow-up results were compared between the two groups. RESULTS: There was no statistically significant difference in the rate of successful device implantation (p > 0.05). Fluoroscopy time, radiation exposure dose, and contrast medium usage in the MLAAO group were higher than those in the SLAAO group (p < 0.001). The procedure time and hospitalization duration were significantly lower in the MLAAO group than those in the SLAAO group (p < 0.001). The occluder compression ratio, measured with fluoroscopy, was lower than that measured with TEE (17.63 ± 3.75% vs. 21.69 ± 4.26%, p < 0.001). Significant differences were observed between the SLAAO group and the MLAAO group (p < 0.05) in terms of oropharyngeal/esophageal injury, hypotension, and dysphagia. At 3 months after LAAO, the MLAAO group had a higher incidence of residual flow within 1-5 mm compared to the SLAAO group, although the difference was not statistically significant. CONCLUSION: MLAAO guided by fluoroscopy, instead of TEE, without general anesthesia simplifies the operational process and may be considered safe, effective, and feasible, especially for individuals who are unable to tolerate or unwilling to undergo TEE or general anesthesia.
Ruan et al. (Fri,) conducted a cohort in Nonvalvular atrial fibrillation (NVAF) (n=249). Minimal left atrial appendage occlusion (MLAAO) under fluoroscopy guidance alone vs. Standard left atrial appendage occlusion (SLAAO) guided by transesophageal echocardiography was evaluated on Successful device implantation (p=> 0.05). Minimal left atrial appendage occlusion guided by fluoroscopy alone achieved similar device implantation success compared to standard TEE guidance (p > 0.05), with shorter procedure times.