Efficacy of 3D‐multidetector computed tomography and fluoroscopy fusion for percutaneous left atrial appendage occlusion procedures

Abstract

AbstractIntroductionWe studied the impact of the use of three‐dimensional multidetector computed tomography (3D‐MDCT) and fluoroscopy fusion on percutaneous left atrial appendage occlusion (LAAO) procedures in relation to procedure time, contrast volume, fluoroscopy time, and total radiation.MethodsThis was a single‐center, prospective, single‐blinded, randomized control trial. Patients meeting criteria for LAAO were randomized to undergo LAAO with the WATCHMAN FLXTM device with and without 3D‐MDCT‐fluoroscopy fusion guidance using a prespecified protocol using computed tomography angiography for WATCHMAN FLXTM sizing, moderate sedation, and intracardiac echocardiography for procedural guidance.ResultsOverall, 59 participants were randomly assigned to the fusion (n = 33) or no fusion (n = 26) groups. The median (interquartile range) age was 79 (75–83) years, 24 (41%) were female, and 55 (93%) were Caucasian. The median CHA2DS2 VASc and HASBLED scores were 5 (4–6) and 3 (3–4), respectively. At the time of the study, 51 (53%) patients were on a direct acting oral anticoagulant. There were no significant differences between the fusion and no fusion groups in procedure time (52.4 ± 15.4 vs. 56.8 ± 19.5 min, p = .36), mean contrast volume used (33.8 ± 12.0 vs. 29.6 ± 11.5 mls, p = .19), mean fluoroscopy time (31.3 ± 9.9 vs. 28.9 ± 8.7 min, p = .32), mean radiation dose (1177 ± 969 vs. 1091 ± 692 mGy, p = .70), and radiation dose product curve (23.9 ± 20.5 vs. 35.0 ± 49.1 Gy cm2, p = .29). There was no periprosthetic leak in the two groups in the immediate 1‐month postprocedure follow‐up periods.ConclusionsThere was no significant difference with and without 3D‐MDCT‐fluoroscopy fusion in procedure time, contrast volume use, radiation dose, and radiation dose product.