Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes

Xiang Li; Zhongyuan Ren; Yixing Zheng; Jingying Zhang; Haotian Yang; Rong Guo; Hailing Li; Jun Zhang; Yiqian Wang; Peng Jia; Dongdong Zhao; Yawei Xu

doi:10.1002/clc.23993

March 9, 2023Clinical CardiologyOpen Access

Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes

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Graphical abstract published by Clinical Cardiology — Graphical abstract · Published by Clinical Cardiology · CC BY

Why the study?

Catheter ablation combined with left atrial appendage occlusion can treat AF, but the safety and efficacy of guiding the combined procedure with DSA alone versus DSA with TEE needed comparison.

Does intraprocedural guidance by digital subtraction angiography alone improve procedural time and maintain safety compared to guidance with transesophageal echocardiography in patients with nonvalvular atrial fibrillation undergoing combined catheter ablation and left atrial appendage occlusion?

Structured PICO

Does intraprocedural guidance by digital subtraction angiography alone improve procedural time and maintain safety compared to guidance with transesophageal echocardiography in patients with nonvalvular atrial fibrillation undergoing combined catheter ablation and left atrial appendage occlusion?

P

Population

138 patients with nonvalvular atrial fibrillation undergoing catheter ablation combined with left atrial appendage occlusion

I

Intervention

Intraprocedural guidance by digital subtraction angiography (DSA) alone

C

Comparator

Intraprocedural guidance by digital subtraction angiography (DSA) with transesophageal echocardiography (TEE)

O

Outcome

Periprocedural and follow-up outcomes (feasibility and safety)

Guiding combined AF ablation and LAAO with DSA alone reduces procedural time while maintaining similar safety and long-term efficacy compared to using DSA with TEE.

Implication

DSA guidance may shorten combined ablation-LAAO procedures with similar safety; leaves open need for RCTs to confirm long-term outcomes.

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and can be treated with catheter ablation (CA) combined with left atrial appendage occlusion (LAAO). The study is designed to compare the safety and efficacy of guiding the combined procedure by digital subtraction angiography (DSA) with or without transesophageal echocardiography (TEE). METHODS: From February 2019 to December 2020, 138 patients with nonvalvular AF who underwent CA combined with LAAO procedure were consecutively included, and two cohorts were built according to intraprocedural guidance (DSA or DSA with TEE). Periprocedural and follow-up outcomes were compared with investigate the feasibility and safety between the two cohorts. RESULTS: 71 patients and 67 patients were included in the DSA cohort and TEE cohort, respectively. Age and gender were comparable, despite the TEE cohort having a higher proportion of persistent AF (37 [55.2%] vs. 26 [36.6%]) and hemorrhage history (9 [13.4%] vs. 0). The procedure time of the DSA cohort was significantly reduced (95.7 ± 27.6 vs. 108.9 ± 30.3 min, p = .018), with a nonsignificant longer fluoroscopic time (15.2 ± 5.4 vs. 14.4 ± 7.1 min, p = .074). And the overall incidence of peri-procedural complications was similar between cohorts. After an average of 24 months of clinical follow-up, only three patients in the TEE cohort had ≤3 mm residual flow (p = .62). Kaplan-Meier estimates showed nonsignificant differences between the cohorts for freedom from atrial arrhythmia (log-rank p = .964) and major adverse cardiovascular events (log-rank p = .502). CONCLUSIONS: Compared with DSA and TEE guidance, DSA-guided combined procedure could shorten the procedural time, while achieving similar periprocedural and long-term feasibility and safety.