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Zero-Contrast Percutaneous Left Atrial Appendage Closure: A Large-Scale, Single-Center, Real-World Study.

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Zero-contrast left atrial appendage closure (LAAC) using TEE and fluoroscopy is safe and effective for stroke prevention in non-valvular atrial fibrillation (AF) patients. This technique offers advantages for those with renal dysfunction, reducing acute kidney injury risk.

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Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Left atrial appendage closure (LAAC) is a stroke prevention strategy for non-valvular atrial fibrillation (AF) patients unsuitable for anticoagulation.
  • Iodinated contrast agents used in LAAC pose a risk of acute kidney injury (AKI), particularly in patients with chronic kidney disease (CKD).
  • Evaluating alternative LAAC techniques that minimize contrast exposure is crucial for patient safety.

Purpose of the Study:

  • To assess the safety and effectiveness of a zero-contrast LAAC procedure.
  • To determine the incidence of major complications and procedural success in zero-contrast LAAC.
  • To evaluate the impact of zero-contrast LAAC on renal function in patients with and without CKD.

Main Methods:

  • A retrospective study of 324 consecutive patients undergoing zero-contrast LAAC between January 2014 and January 2025.
  • Procedures were guided by transesophageal echocardiography (TEE) and fluoroscopy without iodinated contrast agents.
  • Primary safety endpoint was a composite of major complications within 7 days; secondary endpoint was procedural success.

Main Results:

  • The procedure demonstrated a high success rate (99.7%) with a low rate of major complications (2.46%).
  • No cases of acute kidney injury (AKI) were observed during the index hospitalization, and renal function remained stable in patients with pre-existing CKD.
  • Survival rates were significantly lower in patients with progressive renal dysfunction.

Conclusions:

  • Zero-contrast LAAC guided by TEE and fluoroscopy is a safe and effective alternative to contrast-enhanced LAAC.
  • This technique is particularly beneficial for patients with renal dysfunction, mitigating AKI risk.
  • Broader adoption of contrast-avoidance strategies in high-risk populations is supported by these findings.