A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy.
Watchman device
fluoroscopy
minimal left atrial appendage occlusion
nonvalvular atrial fibrillation
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 2024
01 2024
Historique:
revised:
22
08
2023
received:
12
05
2023
accepted:
31
08
2023
medline:
4
1
2024
pubmed:
8
9
2023
entrez:
8
9
2023
Statut:
ppublish
Résumé
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). We aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF. 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. 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. 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
119-128Subventions
Organisme : Jiangsu Provincial Medical Innovation Team
ID : CXTDB2017015
Organisme : Jiangsu Commission of Health
ID : H201665
Informations de copyright
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
Références
Ramlawi B, Abu Saleh WK, Edgerton J. The left atrial appendage: target for stroke reduction in atrial fibrillation. Methodist Debakey Cardiovasc J. 2015;11:100-103.
Sonaglioni A, Lombardo M, Nicolosi GL, Rigamonti E, Anzà C. Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of non-valvular atrial fibrillation patients planned for electrical cardioversion. Int J Cardiovasc Imaging. 2021;37:1539-1550.
Turagam MK, Osmancik P, Neuzil P, Dukkipati SR, Reddy VY. Left atrial appendage closure versus Oral Anticoagulants in atrial fibrillation. JACC. 2020;76(23):2795-2797.
Zhang X, Jin Q, Kong D, et al. Comparison of fluoroscopy and transesophageal echocardiogram for intra-procedure device surveillance assessment during implantation of Watchman. Int J Cardiol. 2021;324:72-77.
Wang J, Rong B, Zhang K, et al. Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: a pilot study. Pacing Clin Electrophysiol. 2021;44:1207-1215.
So C, Lam Y, Cheung GS, et al. Minimalistic approach to left atrial appendage occlusion using the LAmbre device. JACC. 2018;11:1113-1114.
Yuniadi Y, Hanafy DA, Raharjo SB, Yugo D. Left atrial appendage closure device implantation guided with fluoroscopy only: long-term results. J Arrhythm. 2019;35:262-266.
Ruan Z, Wang F, Chen G, Zhu L. A comparative study of three imaging modalities for size selection of a watchman left atrial appendage closure device. Yonsei Med J. 2022;63:325-332.
Meier B, Palacios I, Windecker S, et al. Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation. Catheter Cardiovasc Interv. 2003;60:417-422.
Nietlispach F, Gloekler S, Krause R, et al. Amplatzer left atrial appendage occlusion: single center 10-year experience. Catheter Cardiovasc Interv. 2013;82(2):283-289.
Song Y, Qin SC, Fu X, et al. The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion. Eur Rev Med Pharmacol Sci. 2018;22:5335-5338.
Maarse M, Wintgens LIS, Klaver MN, Rensing BJWM, Swaans MJ, Boersma LVA. Transoesophageal echocardiography guidance with paediatric probes in adults undergoing left atrial appendage occlusion. EuroIntervention. 2021;17(1):93-96.
Hammersley D, Podd S, Gomes A, et al. Feasibility of left atrial appendage occlusion without preprocedural transesophageal echocardiography or CT scanning. J Invasive Cardiol. 2015;27:297-301.
Velagapudi P, Turagam MK, Kolte D, et al. Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: a meta-analysis. J Cardiovasc Electrophysiol. 2019;30:461-467.
Nielsen-Kudsk JE, Berti S, Caprioglio F, et al. Intracardiac echocardiography to guide watchman FLX implantation. JACC. 2023;16:643-651.
Romero J, Husain SA, Kelesidis I, Sanz J, Medina HM, Garcia MJ. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation. Circ Cardiovasc Imag. 2013;6:185-194.
Saw J, Fahmy P, Spencer R, et al. Comparing measurements of CT angiography, TEE, and fluoroscopy of the left atrial appendage for percutaneous closure. J Cardiovasc Electrophysiol. 2016;27:414-422.
Osmancik P, Herman D, Linkova H, Hozman M, Labos M. A comparison of cardiac computed tomography, transesophageal and intracardiac echocardiography, and fluoroscopy for planning left atrial appendage closure. J Atr Fibrillation. 2021;13:20200449.
Gilhofer TS, Abdellatif W, Nicolaou S, et al. Cardiac CT angiography after percutaneous left atrial appendage closure: early versus delayed scanning after contrast administration. Diagn Interv Radiol. 2021;27:703-709.
Glikson M, Wolff R, Hindricks G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion-an update. EP Europace. 2020;22:184.
Qamar SR, Jalal S, Nicolaou S, Tsang M, Gilhofer T, Saw J. Comparison of cardiac computed tomography angiography and transoesophageal echocardiography for device surveillance after left atrial appendage closure. EuroIntervention. 2019;15:663-670.
So C, Cheung GS, Chan AK, Lee AP, Lam Y. A call for standardization in left atrial appendage occlusion. JACC. 2018;72:472-473.