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Long-term outcomes after echocardiography versus fluoroscopy-guided left atrial appendage closure: Is there still a role for a simplified approach?
Gilhofer, Thomas S; Schweiger, Victor; Gehler, Mario; Bokemeyer, Victoria; Chen, Mi; Candreva, Alessandro; Würdinger, Michael; Di Vece, Davide; Templin, Christian; Niederseer, David; Stähli, Barbara E; Stehli, Julia; Gotschy, Alexander; Jakob, Philipp; Ruschitzka, Frank; Binder, Ronald; Nietlispach, Fabian; Michel, Jonathan; Kasel, A Markus.
Afiliação
  • Gilhofer TS; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Schweiger V; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Gehler M; Department of Cardiology, Hospital St. Gallen, St. Gallen, Switzerland.
  • Bokemeyer V; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Chen M; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Candreva A; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Würdinger M; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Di Vece D; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Templin C; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Niederseer D; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Stähli BE; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Stehli J; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Gotschy A; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Jakob P; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
  • Ruschitzka F; Institute for Biomedical Engineering, University and ETH Zurich, Zürich ETH-Zentrum, Zurich, Switzerland.
  • Binder R; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Nietlispach F; Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
  • Michel J; Department of Internal Medicine, Hospital Wels-Grieskirchen, Wels, Austria.
  • Kasel AM; Hirslanden Herzzentrum im Park AG, Zurich, Switzerland.
Catheter Cardiovasc Interv ; 104(2): 343-355, 2024 Aug.
Article em En | MEDLINE | ID: mdl-39031623
ABSTRACT

BACKGROUND:

Left atrial appendage closure (LAAC) represents an alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation (AF). While transoesophageal echocardiography is the current standard for guiding LAAC procedures, several centers have employed fluoroscopic guidance alone. However, data on long-term outcomes are lacking.

METHODS:

A total of 536 patients with AF undergoing LAAC and with available data on long-term follow-up were included in the retrospective, single-center analysis. Outcomes of patients undergoing fluoroscopy-guided LAAC were compared with those undergoing echocardiography guided LAAC. Time-dependent analysis was performed with the Kaplan-Meier method.

RESULTS:

A total of 234 (44%) and 302 (56%) patients were treated with echocardiography and fluoroscopy guidance, respectively. Baseline characteristics did not differ between the two groups. Procedural success rates were high in both groups (97% of fluoroscopy vs. 98% of echocardiography guided procedures; p = 0.92) and rates of relevant peri-device leaks (p = 0.50) and device-related thrombus formation (p = 0.22) did not differ between groups. Median clinical follow-up time was 48 (IQR 19-73) months. Rates of all-cause mortality (p = 0.15, HR 0.83, CI 0.64-1.07) and stroke (p = 0.076, HR 2.23, CI 0.90-5.54) were comparable among groups.

CONCLUSION:

LAAC with fluoroscopy guidance alone is equally safe and leads to similar clinical outcome compared to LAAC with additional echocardiography guidance.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Radiografia Intervencionista / Ultrassonografia de Intervenção / Ecocardiografia Transesofagiana / Acidente Vascular Cerebral / Oclusão do Apêndice Atrial Esquerdo Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Radiografia Intervencionista / Ultrassonografia de Intervenção / Ecocardiografia Transesofagiana / Acidente Vascular Cerebral / Oclusão do Apêndice Atrial Esquerdo Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article