ArticleJournal of cardiovascular electrophysiology2026
Zero-Contrast Versus Contrast-Guided Left Atrial Appendage Occlusion: A Comparative Analysis of Procedural and Long-Term Outcomes.
Article in Journal of cardiovascular electrophysiology, 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
backgroundContrast injection is standard in left atrial appendage occlusion (LAAO) procedures but may be forgone given advances in imaging and device technology. The contrast-free approach remains underexplored.
objectivesTo compare the safety and efficacy of zero-contrast versus contrast-guided LAAO.
methodsAll consecutive patients who underwent LAAO at our center between September 2018 and October 2022 using Watchman FLX™ devices were enrolled in a prospectively maintained registry. A total of 621 patients were divided between zero-contrast (326) and contrast-guided (295) LAAO. Baseline, procedural, and follow-up outcomes were compared. Periprocedural adverse events included major complications within 7 days. LAA closure success was defined as peri-device leak ≤ 5 mm on follow-up imaging.
resultsProcedural success was 100% in zero-contrast and 99.3% in contrast-guided cases (p = 0.2). Periprocedural adverse events occurred in six (1.8%) zero-contrast and two (0.7%) contrast-guided patients (p = 0.3). At 45 days, 297 zero-contrast versus 271 contrast-guided patients had evaluable follow-up imaging. LAA closure success was 99.3% (295) and 99.6% (270), respectively (p > 0.99), while device-related thrombus (DRT) was observed in three patients in each group (1.0% vs. 1.1%, p > 0.99). At 1 year, 68 zero-contrast and 79 contrast-guided patients had TEEs. LAA closure success remained high at 100% in both groups and DRT was observed in three patients from each (4.4% vs. 3.8%, p > 0.99). Ischemic stroke or systemic embolism occurred in 1.9% of zero-contrast patients versus 2.1% in the contrast group within 1 year (p = 0.8).
conclusionsZero-contrast LAAO is a safe, effective, and efficient alternative to contrast-guided implantation, with comparable procedural and clinical outcomes.
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