ReviewJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026
Intraprocedural guidance using fluoroscopy alone for left atrial appendage closure: a systematic review and meta‑analysis.
Review in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn some arrhythmia centers, intraprocedural guidance using fluoroscopy alone remains the mainstream approach for left atrial appendage closure (LAAC). This study aims to synthesize recent literature and assess the feasibility of fluoroscopy‑guided LAAC performed without echocardiography.
methodsA computer-based search was conducted in PubMed, Embase, and the Cochrane Library for studies comparing fluoroscopy alone versus fluoroscopy combined with echocardiography for LAAC, from the inception of each database to September 13, 2025. Summary analysis was conducted using Review Manager 5.4.
resultsThis meta-analysis included 7 studies with 2,472 patients, 1,358 in the Fluoroscopy group and 1,114 in the combined fluoroscopy‑echocardiography group (Standard group). Both groups achieved high immediate procedural success rates, with a higher rate in the Standard group (RR 0.98, 95% CI 0.96-1.00, P = 0.030), but the difference was minimal. Fluoroscopy-guided LAAC increased fluoroscopy time (MD 1.89, 95% CI 1.61-2.17, P < 0.001) but shortened procedure time (MD -12.92, 95% CI -18.96 to -6.89, P < 0.001). Overall perioperative complications showed no significant differences between groups (RR 0.93, 95% CI 0.51-1.69, P = 0.810). In follow-up, the incidence of peri-device leak (PDL), device-related thrombosis (DRT), and stroke/TIA or death were similar between groups.
conclusionBoth intraprocedural guidance strategies for LAAC achieve high immediate procedural success rates. Although the Standard group showed a higher success rate, the advantage was minimal. The two strategies are comparable in terms of perioperative and follow-up complications. Overall, current evidence supports that fluoroscopy-guided LAAC alone is feasible by experienced operators in settings with limited resources.
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