Long‐term outcomes after echocardiography versus fluoroscopy‐guided left atrial appendage closure: Is there still a role for a simplified approach?

Background Left atrial appendage closure (LAAC) represents an alternative to oral anticoagulation for stroke prevention in patients with non‐valvular atrial fibrillation (AF). While transoesophageal echocardiography is the current standard for guiding LAAC procedures, several centers have employed fluoroscopic guidance alone. However, data on long‐term outcomes are lacking. Methods A total of 536 patients with AF undergoing LAAC and with available data on long‐term follow‐up were included in the retrospective, single‐center analysis. Outcomes of patients undergoing fluoroscopy‐guided LAAC were compared with those undergoing echocardiography guided LAAC. Time‐dependent analysis was performed with the Kaplan–Meier method. Results A total of 234 (44%) and 302 (56%) patients were treated with echocardiography and fluoroscopy guidance, respectively. Baseline characteristics did not differ between the two groups. Procedural success rates were high in both groups (97% of fluoroscopy vs. 98% of echocardiography guided procedures; p = 0.92) and rates of relevant peri‐device leaks (p = 0.50) and device‐related thrombus formation (p = 0.22) did not differ between groups. Median clinical follow‐up time was 48 (IQR 19–73) months. Rates of all‐cause mortality (p = 0.15, HR 0.83, CI 0.64–1.07) and stroke (p = 0.076, HR 2.23, CI 0.90–5.54) were comparable among groups. Conclusion LAAC with fluoroscopy guidance alone is equally safe and leads to similar clinical outcome compared to LAAC with additional echocardiography guidance.