CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation
Objectives: The aim of this study was to determine whether the application of a CT-based preplanning algorithm might allow abstaining from TEE during LAAC. Background: LAAC is an established treatment alternative for patients with atrial fibrillation. Today, most LAAC procedures are guided by TEE, w...
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| Format: | Article |
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MDPI AG
2023-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/12/4019 |
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| author | Alexandra Offhaus Luisa Linss Peter Roehl Charlotte Sakriss Uta Pertschy Andreas Schwenzky Henning Ebelt |
| author_facet | Alexandra Offhaus Luisa Linss Peter Roehl Charlotte Sakriss Uta Pertschy Andreas Schwenzky Henning Ebelt |
| author_sort | Alexandra Offhaus |
| collection | DOAJ |
| description | Objectives: The aim of this study was to determine whether the application of a CT-based preplanning algorithm might allow abstaining from TEE during LAAC. Background: LAAC is an established treatment alternative for patients with atrial fibrillation. Today, most LAAC procedures are guided by TEE, which, however, leads to the need for patient sedation and might even cause direct harm to the patient. CT-based preplanning of the LAAC procedure, in combination with technical improvements in device design and interventional experience, might allow abstaining from TEE. Methods: Fluoro-FLX is a prospective single-center study to evaluate how often TEE leads to a procedural change during interventional LAAC if a dedicated CT planning algorithm is applied. The study hypothesis is that under these circumstances, a sole fluoroscopy-guided LAAC is an alternative to a TEE-guided approach. All procedures are preplanned by cardiac CT and, finally, guided by fluoroscopy only, while TEE is carried out in the background during the intervention for safety reasons. Results: In none of the 31 consecutive patients did TEE lead to a change in the preplanned fluoroscopy-guided LAAC (success ratio: 1.00; CI: 0.94–1.00), thereby meeting the primary endpoint (performance goal: 0.90). There were no procedure-related adverse cardiac or cerebrovascular events (no pericardial effusion, TIA, stroke, systemic embolism, device embolism, death). Conclusions: Our data suggest that it is feasible to perform LAAC under sole fluoroscopic guidance if preplanning is performed using cardiac CT. This might be worth considering, especially in patients who are at high risk for TEE-related adverse events. |
| first_indexed | 2024-03-11T02:18:11Z |
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| id | doaj.art-38a042c1ca2a4dce806c3ab0ce7f6d70 |
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| language | English |
| last_indexed | 2024-03-11T02:18:11Z |
| publishDate | 2023-06-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-38a042c1ca2a4dce806c3ab0ce7f6d702023-11-18T10:59:51ZengMDPI AGJournal of Clinical Medicine2077-03832023-06-011212401910.3390/jcm12124019CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial FibrillationAlexandra Offhaus0Luisa Linss1Peter Roehl2Charlotte Sakriss3Uta Pertschy4Andreas Schwenzky5Henning Ebelt6Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment for Radiology and Imaging, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyDepartment of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, GermanyObjectives: The aim of this study was to determine whether the application of a CT-based preplanning algorithm might allow abstaining from TEE during LAAC. Background: LAAC is an established treatment alternative for patients with atrial fibrillation. Today, most LAAC procedures are guided by TEE, which, however, leads to the need for patient sedation and might even cause direct harm to the patient. CT-based preplanning of the LAAC procedure, in combination with technical improvements in device design and interventional experience, might allow abstaining from TEE. Methods: Fluoro-FLX is a prospective single-center study to evaluate how often TEE leads to a procedural change during interventional LAAC if a dedicated CT planning algorithm is applied. The study hypothesis is that under these circumstances, a sole fluoroscopy-guided LAAC is an alternative to a TEE-guided approach. All procedures are preplanned by cardiac CT and, finally, guided by fluoroscopy only, while TEE is carried out in the background during the intervention for safety reasons. Results: In none of the 31 consecutive patients did TEE lead to a change in the preplanned fluoroscopy-guided LAAC (success ratio: 1.00; CI: 0.94–1.00), thereby meeting the primary endpoint (performance goal: 0.90). There were no procedure-related adverse cardiac or cerebrovascular events (no pericardial effusion, TIA, stroke, systemic embolism, device embolism, death). Conclusions: Our data suggest that it is feasible to perform LAAC under sole fluoroscopic guidance if preplanning is performed using cardiac CT. This might be worth considering, especially in patients who are at high risk for TEE-related adverse events.https://www.mdpi.com/2077-0383/12/12/4019left atrial appendageatrial fibrillationLAAC |
| spellingShingle | Alexandra Offhaus Luisa Linss Peter Roehl Charlotte Sakriss Uta Pertschy Andreas Schwenzky Henning Ebelt CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation Journal of Clinical Medicine left atrial appendage atrial fibrillation LAAC |
| title | CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation |
| title_full | CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation |
| title_fullStr | CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation |
| title_full_unstemmed | CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation |
| title_short | CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation |
| title_sort | ct based preplanning allows abstaining from intraprocedural tee during interventional closure of the laa in patients with atrial fibrillation |
| topic | left atrial appendage atrial fibrillation LAAC |
| url | https://www.mdpi.com/2077-0383/12/12/4019 |
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