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Contrast-free, echocardiography-guided left atrial appendage occlusion (LAAo): a propensity-matched comparison with conventional LAAo using the AMPLATZER™ Amulet™ device

Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Aims

Percutaneous left atrial appendage occlusion (LAAo) is commonly performed under fluoroscopy including the use of contrast dye. In this study, we aimed to assess feasibility and safety of contrast-free, 3D-echo-based LAAo with the use of the AMPLATZER™ Amulet™ device.

Methods and results

We analyzed 20 patients (74 ± 10 years, 65% males) at an increased thromboembolic and bleeding risk (CHA2DS2VASC 4.0 ± 1.3; HAS-BLED 3.5 ± 0.9) with chronic renal failure (GFR 41 ± 21 ml/min) undergoing LAAo without the use of contrast dye at our center and compared the results with a propensity-matched cohort (1:1 matching) of conventionally treated patients receiving contrast agent. Contrast-free LAAo was associated with less radiation exposure (13.1 ± 19.2 vs. 32.9 ± 21.2 Gy*cm2, p < 0.01) and fluoroscopy time (5.0 ± 3.4 vs. 11.6 ± 4.9 min, p < 0.01). Procedural success rates were excellent in both groups (100%) without severe periprocedural complications (i.e. procedural death, stroke/systemic embolism, myocardial infarction, cardiac tamponade or major bleeding).

Conclusions

Echocardiographically guided LAAo without the use of contrast dye appears safe and feasible. This approach appears to be associated with reduced radiation exposure and may represent an alternative to traditional LAAo, especially in patients in whom the avoidance of contrast dye is warranted.

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Fig. 1
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Abbreviations

BMI:

Body mass index

CHA2DS2VASC:

CHA2DS2VASC-score

CT:

Computed tomography

Dmax/Dmin:

Maximal/minimal diameter (of the LAA ostium)

DRT:

Device-related thrombus

HAS-BLED:

HAS-BLED-score

GFR:

Glomerular filtration rate

LAA:

Left atrial appendage

LAAo:

Left atrial appendage occlusion

LVEF:

Left ventricular ejection fraction

MAE:

Major adverse event

TEE:

Transesophageal echocardiography

VARC:

Valve academic research consortium

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Acknowledgements

We would like to thank GE for providing material support to this study.

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Correspondence to Alexander Sedaghat.

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Conflict of interest

AS, BAK and RS have received travel grants from St. Jude Medical/Abbott. GN has received speaker honoraria from St. Jude Medical/Abbott. HO is a consultant and proctor for St. Jude Medical/Abbott. All other authors report no conflict of interest.

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Sedaghat, A., Al-Kassou, B., Vij, V. et al. Contrast-free, echocardiography-guided left atrial appendage occlusion (LAAo): a propensity-matched comparison with conventional LAAo using the AMPLATZER™ Amulet™ device. Clin Res Cardiol 108, 333–340 (2019). https://doi.org/10.1007/s00392-018-1401-5

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  • DOI: https://doi.org/10.1007/s00392-018-1401-5

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