Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure

Aims To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure. Methods and Results In this open-label single-center study LAA closure (Amplatzer (TM) Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1 +/- 8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator (R) [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5 +/- 30.7 vs. EN-: 93.9 +/- 64.4 Gy/cm(2); p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7 +/- 7 vs. EN-: 24.0 +/- 11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6 +/- 28.8 vs. 90.1 +/- 30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3 +/- 92.7 vs. 197.5 +/- 127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1 +/- 5.9 months) no device-related events occurred. Conclusions Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.