Key result
Fluoroscopy alone for LAAC yields ~2% lower immediate procedural success versus combined guidance.
Why the study?
Intraprocedural guidance using fluoroscopy alone remains mainstream for LAAC in some centres, motivating an assessment of its feasibility without echocardiography.
Does intraprocedural guidance using fluoroscopy alone maintain procedural success and safety compared to fluoroscopy combined with echocardiography in patients undergoing left atrial appendage closure?
Meta-Analysis (n=2,472)
Does intraprocedural guidance using fluoroscopy alone maintain procedural success and safety compared to fluoroscopy combined with echocardiography in patients undergoing left atrial appendage closure?
Relative Risk: 0.98 (95% CI 0.96–1)
p-value: p=0.030
Fluoroscopy-guided LAAC alone is feasible, achieving comparable safety and slightly lower but high procedural success compared to combined fluoroscopy-echocardiography guidance, making it a viable option in resource-limited settings.
Fluoroscopy-alone LAAC maintains high success and safety; extends evidence for echocardiography-free use in resource-limited settings.
Background In some arrhythmia centers, intraprocedural guidance using fluoroscopy alone remains the mainstream approach for left atrial appendage closure (LAAC). This study aims to synthesize recent literature and assess the feasibility of fluoroscopy‑guided LAAC performed without echocardiography. Methods A computer-based search was conducted in PubMed, Embase, and the Cochrane Library for studies comparing fluoroscopy alone versus fluoroscopy combined with echocardiography for LAAC, from the inception of each database to September 13, 2025. Summary analysis was conducted using Review Manager 5.4. Results This meta-analysis included 7 studies with 2,472 patients, 1,358 in the Fluoroscopy group and 1,114 in the combined fluoroscopy‑echocardiography group (Standard group). Both groups achieved high immediate procedural success rates, with a higher rate in the Standard group (RR 0.98, 95% CI 0.96–1.00, P = 0.030), but the difference was minimal. Fluoroscopy-guided LAAC increased fluoroscopy time (MD 1.89, 95% CI 1.61–2.17, P < 0.001) but shortened procedure time (MD -12.92, 95% CI -18.96 to -6.89, P < 0.001). Overall perioperative complications showed no significant differences between groups (RR 0.93, 95% CI 0.51–1.69, P = 0.810). In follow-up, the incidence of peri-device leak (PDL), device-related thrombosis (DRT), and stroke/TIA or death were similar between groups. Conclusion Both intraprocedural guidance strategies for LAAC achieve high immediate procedural success rates. Although the Standard group showed a higher success rate, the advantage was minimal. The two strategies are comparable in terms of perioperative and follow-up complications. Overall, current evidence supports that fluoroscopy-guided LAAC alone is feasible by experienced operators in settings with limited resources.
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Li et al. (2026) conducted a meta-analysis in Left atrial appendage closure (n=2,472). Fluoroscopy alone vs. Fluoroscopy combined with echocardiography was evaluated on immediate procedural success rates (RR 0.98, 95% CI 0.96-1.00, p=0.030). Fluoroscopy alone for left atrial appendage closure yielded a minimally lower immediate procedural success rate than combined guidance (RR 0.98; 95% CI 0.96-1.00; P=0.030).
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