Related Experiment Video
Updated: May 26, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Comparison of zero-contrast left atrial appendage occlusion to contrast-guided left atrial appendage occlusion
Maciej Cieślik1, Michał Malinowski2, Michał Dąbrowski2,3
1Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland. maciejcieslik77@gmail.com.
Background:
Left atrial appendage occlusion (LAAO) is a well-established interventional method forpreventing thromboembolic events in patients with atrial fibrillation. Evidence on performing percutaneousLAAO without contrast, particularly with the Amplatzer™ Amulet™ device, remains limited.
Aims:
This study aimed to compare the safety and efficacy of zero-contrast LAAO with contrast-guided implantation, and to evaluate device-specific outcomes in a contrast-free setting.
Methods:
This retrospective analysis included 159 patients: 84 underwent zero-contrast LAAO, and75 underwent contrast-guided LAAO. Safety endpoints included periprocedural bleeding, deviceembolization, and pericardial effusion. Efficacy endpoints included stroke, peripheral embolism,in-hospital and 30-day mortality, device-related thrombus, and peridevice leak (PDL) at 30 days. A subgroupanalysis by device type (Watchman™, Amulet™) was conducted within the zero-contrast group.
Results:
No peripheral embolism or device embolization occurred in either group. One strokeoccurred in the contrast-guided group. There were no in-hospital or 30-day deaths in either group.Echocardiographic outcomes, including PDL (28% with contrast vs. 27% without contrast; P = 0.93)and device-related thrombus (5% vs. 6%; P = 0.87), did not differ significantly between groups. Safetyoutcomes were also comparable for pericardial effusion (3% vs. 4%; P = 0.74) and access-site bleeding(8% vs. 6%; P = 0.61). In the zero-contrast group, Watchman™ devices were associated with a higherprevalence of PDL than Amulet™ (36% vs. 23%; P = 0.02).
Conclusions:
Zero-contrast LAAO may be as safe and effective as contrast-guided LAAO. It may beparticularly beneficial in patients with renal impairment. A borderline higher PDL rate was observedwith the Watchman™ device.
