Comparison of zero-contrast left atrial appendage occlusion to contrast-guided left atrial appendage occlusion

BACKGROUND: Left atrial appendage occlusion (LAAO) is a well-established interventional method for preventing thromboembolic events in patients with atrial fibrillation. Evidence on performing percutaneous LAAO without contrast, particularly with the Amplatzer™ Amulet™ device, remains limited. AIMS: This study aimed to compare the safety and efficacy of zero-contrast LAAO with contrast-guided implantation and to evaluate device-specific outcomes in a contrast-free setting. METHODS: This retrospective analysis included 159 patients: 84 underwent zero-contrast LAAO, and 75 underwent contrast-guided LAAO. Safety endpoints included periprocedural bleeding, device embolization, and pericardial effusion. Efficacy endpoints included stroke, peripheral embolism, in-hospital and 30-day mortality, device-related thrombus, and peridevice leak (PDL) at 30 days. A subgroup analysis by device type (WATCHMAN™, Amulet™) was conducted within the zero-contrast group. RESULTS: No peripheral embolism or device embolization occurred in either group. One stroke occurred in the contrast-guided group. There were no in-hospital or 30-day deaths in either group. Echocardiographic outcomes, including PDL (28% with contrast vs. 27% without contrast; P = 0.93) and device-related thrombus (5% vs. 6%; P = 0.87), did not differ significantly between groups. Safety outcomes were also comparable: pericardial effusion (3% vs. 4%; P = 0.74) and access-site bleeding (8% vs. 6%; P = 0.61). In the zero-contrast group, WATCHMAN™ devices were associated with a higher incidence of PDL than Amulet™ (36% vs. 23%; P = 0.02). CONCLUSIONS: Zero-contrast LAAO may be as safe and effective as contrast-guided LAAO. It may be particularly beneficial in patients with renal impairment. A borderline higher PDL rate was observed with the WATCHMAN™ device.