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Updated: Oct 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Zero-fluoroscopy approach to left atrial appendage closure using intracardiac echo guidance
Michael H Hoskins1, Michael Bestawros1, Sandeep Nair1
1New Mexico Heart Institute, Lovelace Heart Hospital of New Mexico, Albuquerque, NM.
Background:
Left atrial appendage closure (LAAC) with the Watchman™ device is typically performed with the use of transesophageal echocardiography (TEE) and fluoroscopy. LAAC guided by intracardiac echo (ICE) without the use of fluoroscopy has not been previously described.
Objective:
In this series, we describe the safety and feasibility of Watchman™ implantation using only ICE imaging and without the use of fluoroscopy.
Methods:
214 patients undergoing LAAC with the Watchman FLX™ or Watchman FLX™ Pro device and using a planned fluoroscopy-free approach were studied. ICE was used for echocardiographic imaging in all cases. TEE was not used in any cases. Fluoroscopy was used as a bail-out approach when it was felt to be clinically necessary by the operator. Peri-procedural, 45-day, and 1-year efficacy and safety outcomes were assessed.
Results:
In 203/214 patients (94.8%), LAAC was completed without the use of fluoroscopy. Bail-out fluoroscopy was required in 11/214 patients (5.1%). Successful device implantation was completed in 212/214 patients (99.1%). The rate of any peri-device leak at 45 days post-procedure was 11.6%. Procedural complications were limited to one pericardial effusion and one case of ventricular tachycardia.
Conclusion:
LAAC with the Watchman™ device using ICE imaging and without the use of fluoroscopy appears to be safe and effective. The rates of procedural success, complications, and peri-device leaks on 45 day follow up were consistent with that seen in pivotal clinical trials. Further studies are needed to assess the broader applicability of this technique.
