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Updated: Apr 9, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Long-term outcomes after echocardiography versus fluoroscopy-guided left atrial appendage closure: Is there still a
Thomas S Gilhofer1, Victor Schweiger1, Mario Gehler2
1Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
Insights
Fluoroscopic guidance alone for left atrial appendage closure (LAAC) is as safe and effective as using echocardiography. This study shows similar long-term outcomes for stroke prevention in atrial fibrillation patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation (AF).
- Transesophageal echocardiography (TEE) is the standard guidance, but fluoroscopy-only guidance is used in some centers.
- Long-term outcome data for fluoroscopy-guided LAAC are limited.
Purpose of the Study:
- To compare the long-term safety and efficacy of fluoroscopy-guided LAAC versus echocardiography-guided LAAC.
- To evaluate procedural success, peri-device leaks, device-related thrombus, mortality, and stroke rates.
Main Methods:
- Retrospective, single-center analysis of 536 patients with AF undergoing LAAC.
- Comparison of outcomes between patients treated with echocardiography-guided LAAC and fluoroscopy-guided LAAC.
- Time-dependent analysis using the Kaplan-Meier method for long-term follow-up.
Main Results:
- Procedural success rates were high and similar in both groups (97% fluoroscopy vs. 98% echocardiography).
- Rates of peri-device leaks and device-related thrombus did not differ significantly between groups.
- Long-term follow-up (median 48 months) showed comparable rates of all-cause mortality and stroke between the two guidance methods.
Conclusions:
- Left atrial appendage closure using fluoroscopy guidance alone is a safe and effective alternative.
- Fluoroscopy-guided LAAC yields similar clinical outcomes compared to echocardiography-guided LAAC.
- This supports the use of fluoroscopy-only guidance in select cases, potentially reducing procedural costs and complexity.
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.
