Safety and efficacy of ultralow-dose fluoroscopy in left atrial appendage occlusion

Minimizing radiation exposure has become a growing priority in electrophysiology, with increasing adoption of zero- or minimal-fluoroscopy techniques. Little is known about left atrial appendage occlusion (LAAO) using ultralow-dose fluoroscopy.

This study aimed to assess the safety and efficacy of an ultralow-dose fluoroscopy strategy for LAAO.

In a prospectively maintained registry at our center, 46 patients underwent LAAO with ultralow-dose fluoroscopy using Watchman FLX devices (Boston Scientific, Minneapolis, MN). The ultralow-dose strategy was a priori planned for these patients with the goal of minimizing radiation exposure (total radiation exposure <10 mGy), while relying on transesophageal echocardiography guidance for device placement. The ultralow-dose fluoroscopy group was compared using propensity score matching with patients treated with standard fluoroscopy guidance (1:3 matching; n = 46 vs 138). Baseline characteristics, procedural metrics, and clinical outcomes were compared between groups.

Procedural success was 100% in both groups, with significantly shorter procedural duration in the ultralow-dose group (42 vs 60 minutes; P < .001). Periprocedural adverse events were infrequent and did not differ significantly (none in ultralow dose vs 3 cases [2.2%] in standard dose; P = .6). Closure success at 45 days was high in both groups (97.8% vs 100%; P = .3). Device-related thrombus occurred in 1 ultralow-dose patient (2.2%)-with none in the standard group (P = .3)-and resolved without sequelae with anticoagulation. The 1-year rate of ischemic stroke or systemic embolism was similarly low between groups, with 2 (4.3%) vs 3 events (2.2%), respectively (P = .4).

Ultralow-dose fluoroscopy is a safe and effective, radiation-sparing strategy for LAAO.