Key result
Zero-contrast LAAO achieves comparable 45-day closure success to contrast-guided closure without added adverse events.
Why the study?
Contrast injection is standard during LAAO procedures, but a contrast-free approach made possible by advanced imaging and device technology remains underexplored.
Does a zero-contrast approach to left atrial appendage occlusion (LAAO) safely and effectively compare to standard contrast-guided LAAO in patients requiring stroke prevention?
Cohort (n=621)
No
Does a zero-contrast approach to left atrial appendage occlusion (LAAO) safely and effectively compare to standard contrast-guided LAAO in patients requiring stroke prevention?
Zero-contrast LAAO was associated with comparable closure and safety; leaves open need for randomized trials before practice change.
BACKGROUND: Contrast injection is standard in left atrial appendage occlusion (LAAO) procedures but may be forgone given advances in imaging and device technology. The contrast-free approach remains underexplored. OBJECTIVES: To compare the safety and efficacy of zero-contrast versus contrast-guided LAAO. METHODS: All consecutive patients who underwent LAAO at our center between September 2018 and October 2022 using Watchman FLX™ devices were enrolled in a prospectively maintained registry. A total of 621 patients were divided between zero-contrast (326) and contrast-guided (295) LAAO. Baseline, procedural, and follow-up outcomes were compared. Periprocedural adverse events included major complications within 7 days. LAA closure success was defined as peri-device leak ≤ 5 mm on follow-up imaging. RESULTS: Procedural success was 100% in zero-contrast and 99.3% in contrast-guided cases (p = 0.2). Periprocedural adverse events occurred in six (1.8%) zero-contrast and two (0.7%) contrast-guided patients (p = 0.3). At 45 days, 297 zero-contrast versus 271 contrast-guided patients had evaluable follow-up imaging. LAA closure success was 99.3% (295) and 99.6% (270), respectively (p > 0.99), while device-related thrombus (DRT) was observed in three patients in each group (1.0% vs. 1.1%, p > 0.99). At 1 year, 68 zero-contrast and 79 contrast-guided patients had TEEs. LAA closure success remained high at 100% in both groups and DRT was observed in three patients from each (4.4% vs. 3.8%, p > 0.99). Ischemic stroke or systemic embolism occurred in 1.9% of zero-contrast patients versus 2.1% in the contrast group within 1 year (p = 0.8). CONCLUSIONS: Zero-contrast LAAO is a safe, effective, and efficient alternative to contrast-guided implantation, with comparable procedural and clinical outcomes.
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Demian et al. (2026) conducted a cohort in Atrial Fibrillation (n=621). Zero-contrast left atrial appendage occlusion vs. Contrast-guided left atrial appendage occlusion was evaluated on LAA closure success at 45 days (peri-device leak ≤ 5 mm) (p=>0.99). Zero-contrast LAAO achieved comparable 45-day LAA closure success (99.3%) compared to the standard contrast-guided approach (99.6%, p > 0.99) without an increase in periprocedural adverse events.
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