Comparison of fluoroscopy and transesophageal echocardiogram for intra-procedure device surveillance assessment during implantation of Watchman. (1st February 2021)

• Record Type: Journal Article
• Authors: Zhang, Xiaochun; Jin, Qinchun; Kong, Dehong; Jiang, Yingying; Chen, Shasha; Chen, Dandan; Hou, Cody R.; Zhang, Lei; Pan, Cuizhen; Zhou, Daxin; Ge, Junbo
• Is Part Of: International journal of cardiology. Volume 324(2021)
• Page Start: 72
• Page End: 77
• Publication Date: 2021-02-01
• Subjects: Left atrial appendage occlusion -- Atrial fibrillation -- Transesophageal echocardiogram -- Fluoroscopy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.08.070
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objectives: To evaluate intraprocedural assessments using transesophageal echocardiography (TEE) and fluoroscopy during left atrial appendage occlusion (LAAO) with the WATCHMAN device. Method: A total of 208 patients with non-valvular atrial fibrillation (AF) undergoing LAAO were included in this study[101 standard procedures (retrospective cohort) and 107 with fluoroscopy-alone approach (prospective cohort). Individual device position, anchoring, compression and peri-device leak (PDL) were successively analyzed based on TEE and fluoroscopy in the retrospective cohort to summarize detailed fluoroscopic assessments for prospective application. Clinical outcomes were assessed between two cohorts. Results: For retrospective cohort, TEE and fluoroscopy agreed on device position and anchoring. Compression upon fluoroscopy was well correlated with 2D-TEE ( r = 0.908) and the difference in overall detection of PDL was not statistically significant between two imaging modalities ( p = 0.304). For the prospective cohort with fluoroscopy-guidance alone, implantation success was similar to that of the retrospective cohort (98.13% vs 100%, p = 0.498). The incidence rate of major clinical adverse events was relatively higher in prospective cohort during hospitalization and follow-up but did not reach significant difference (5.61% vs 1.98%; 0.99% vs 0.93%, p > 0.05). Moreover, the prospective group presented with shorter procedural duration, shorter in-hospital stay and lower total hospitalization cost than retrospective group. Conclusion: LAAO performed by experienced operators in large volume centers is feasible under fluoroscopy guidance. However, there is still a trend in favor of TEE for greater procedural safety and more complete LAA seal. We suggest that this minimalist approach could be proposed in cases with contraindication to general anesthesia and/or TEE. Graphical abstract: Unlabelled Image Highlights: For experienced operators in large volume centers, LAAO performed with fluoroscopic guidance under local anesthesia is feasible and safe. However, our findings suggest that there is a trend in favor of TEE for a greater safety of the procedure, allowing to achieve a more complete seal of the appendage. LAA implantation using fluoroscopy-alone approach could be proposed for patients with strong contra-indications for general anesthesia and/or transesophageal echocardiography.