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

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)...

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Autores principales: Meng, Weilun, Li, Xiang, Ren, Zhongyuan, Zheng, Yixing, Zhang, Jingying, Yang, Haotian, Guo, Rong, Li, Hailing, Zhang, Jun, Wang, Yiqian, Jia, Peng, Zhao, Dongdong, Xu, Yawei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189077/
https://www.ncbi.nlm.nih.gov/pubmed/36896458
http://dx.doi.org/10.1002/clc.23993
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author Meng, Weilun
Li, Xiang
Ren, Zhongyuan
Zheng, Yixing
Zhang, Jingying
Yang, Haotian
Guo, Rong
Li, Hailing
Zhang, Jun
Wang, Yiqian
Jia, Peng
Zhao, Dongdong
Xu, Yawei
author_facet Meng, Weilun
Li, Xiang
Ren, Zhongyuan
Zheng, Yixing
Zhang, Jingying
Yang, Haotian
Guo, Rong
Li, Hailing
Zhang, Jun
Wang, Yiqian
Jia, Peng
Zhao, Dongdong
Xu, Yawei
author_sort Meng, Weilun
collection PubMed
description 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.
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spelling pubmed-101890772023-05-18 Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes Meng, Weilun Li, Xiang Ren, Zhongyuan Zheng, Yixing Zhang, Jingying Yang, Haotian Guo, Rong Li, Hailing Zhang, Jun Wang, Yiqian Jia, Peng Zhao, Dongdong Xu, Yawei Clin Cardiol Clinical Trial 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. John Wiley and Sons Inc. 2023-03-09 /pmc/articles/PMC10189077/ /pubmed/36896458 http://dx.doi.org/10.1002/clc.23993 Text en © 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Trial
Meng, Weilun
Li, Xiang
Ren, Zhongyuan
Zheng, Yixing
Zhang, Jingying
Yang, Haotian
Guo, Rong
Li, Hailing
Zhang, Jun
Wang, Yiqian
Jia, Peng
Zhao, Dongdong
Xu, Yawei
Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title_full Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title_fullStr Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title_full_unstemmed Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title_short Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
title_sort guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes
topic Clinical Trial
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189077/
https://www.ncbi.nlm.nih.gov/pubmed/36896458
http://dx.doi.org/10.1002/clc.23993
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