Safety and efficacy of ultralow-dose fluoroscopy in left atrial appendage occlusion

Le résumé fourni par la source

Background Minimizing radiation exposure has become a growing priority in electrophysiology, with increasing adoption of zero- or minimal-fluoroscopy techniques. Little is known about left atrial appendage occlusion (LAAO) using ultra-low-dose fluoroscopy. Objective To assess the safety and efficacy of an ultra-low-dose fluoroscopy strategy for LAAO. Methods In a prospectively maintained registry at our center, 46 patients underwent LAAO with ultra-low-dose fluoroscopy using Watchman FLX devices (Boston Scientific, USA). The ultra-low-dose strategy was a priori planned in these patients with the goal of minimizing radiation exposure (total radiation exposure <10 mGy), while relying on transesophageal echocardiography (TEE) guidance for device placement. The ultra-low-dose fluoroscopy group was compared using propensity score matching to patients treated with standard fluoroscopy guidance (1:3 matching; n=46 vs. 138). Baseline characteristics, procedural metrics, and clinical outcomes were compared between groups. Results Procedural success was 100% in both groups, with significantly shorter procedural duration in the ultra-low-dose group (42 vs. 60 minutes, p<0.001). Periprocedural adverse events were infrequent and did not differ significantly (none in ultra-low-dose vs. three cases (2.2%) in standard-dose, p=0.6). Closure success at 45 days was high in both groups (97.8% vs. 100%, p=0.3). Device-related thrombus occurred in one ultra-low-dose patient (2.2%) – with none in the standard group (p=0.3) – and resolved without sequelae with anticoagulation. The one-year rate of ischemic stroke or systemic embolism was similarly low between groups, with two (4.3%) vs. three (2.2%) events, respectively (p=0.4). Conclusion Ultra-low-dose fluoroscopy is a safe and effective, radiation-sparing strategy for LAAO.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.