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

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.