Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study

Abstract

Objective Assessing the Efficacy, Safety, and Economic Analysis of Transcatheter Closure of Left Atrial Appendage with Guidance of Perspective Directing Catheter Ablation Procedure. Methods The study included patients with non-valvular atrial fibrillation who were admitted to the Seventh People's Hospital, Zhengzhou City, and underwent catheter ablation from March 2017 to April 2022. These patients were divided into two groups, the transesophageal echocardiography combined with fluoroscopy group (TEE group, n = 73) and the fluoroscopy-guided group (DSA group, n = 73), using propensity score matching. Perioperative and follow-up data were compared to assess the efficacy, safety and cost-effectiveness of fluoroscopy-guided left atrial appendage closure combined with catheter ablation. Results Both groups of patients successfully completed catheter ablation and left atrial appendage occlusion, with similar procedure times (P > 0.05), indicating no statistical difference. In total, 4 patients experienced pericardial effusion and 1 patient experienced vagal reflex (P > 0.05), but there were no statistically significant differences. Regarding the occurrence of minimal pericardial effusion, there was a statistically significant difference between the DSA group and the TEE group (P < 0.05), suggesting that the DSA group may have an advantage. Additionally, there were statistically significant differences between the DSA group and the TEE group in terms of hospitalization period and expenses (P < 0.05). During the follow-up period, there were no statistically significant differences between the two groups in terms of atrial fibrillation recurrence, re-ablation, stroke/transient ischemic attack, and embolism. There were also no statistically significant differences in terms of all-cause mortality, all-cause rehospitalization, cardiovascular event rehospitalization, and major bleeding. Likewise, there were no statistically significant differences in terms of device displacement, residual shunting related to the device, and device-related thrombosis. Conclusions For the left atrial appendage occlusion combined with catheter ablation, the effectiveness and safety of DSA alone are not inferior to DSA combined with TEE guidance, and it has certain advantages in reducing hospital costs and length of stay.