Intraprocedural guidance using fluoroscopy alone for left atrial appendage closure: a systematic review and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Fluoroscopy alone is a mainstream guidance method for left atrial appendage closure (LAAC) in some centers.
• Echocardiography is often used in conjunction with fluoroscopy for LAAC.
• The feasibility of LAAC using only fluoroscopy requires further assessment.

Purpose of the Study:

• To synthesize recent literature on fluoroscopy-guided LAAC.
• To assess the feasibility and outcomes of LAAC performed without echocardiography.
• To compare fluoroscopy-guided LAAC with combined fluoroscopy-echocardiography guidance.

Main Methods:

• A systematic literature search was performed in PubMed, Embase, and Cochrane Library.
• Studies comparing fluoroscopy alone versus combined guidance for LAAC were included.
• Meta-analysis was conducted using Review Manager 5.4.

Main Results:

• Included 7 studies with 2,472 patients; 1,358 in the fluoroscopy group and 1,114 in the standard group.
• Both groups had high immediate procedural success rates; the standard group had a minimal advantage (RR 0.98).
• Fluoroscopy guidance increased fluoroscopy time but shortened procedure time, with similar perioperative and follow-up complication rates.

Conclusions:

• Both guidance strategies for LAAC achieve high success rates.
• Fluoroscopy-guided LAAC alone is comparable to standard guidance in terms of efficacy and safety.
• This approach is feasible for experienced operators in resource-limited settings.