PO-638-07 GUIDING CATHETER ABLATION COMBINED WITH LEFT ATRIAL APPENDAGE OCCLUSION PROCEDURE BY FLUOROSCOPY WITH OR WITHOUT TRANSESOPHAGEAL ECHOCARDIOGRAPHY ACHIEVED COMPARABLE OUTCOMES

Abstract

Several studies published the safety and efficacy of performing catheter ablation (CA) combined with left atrial appendage occlusion (LAAC) guided by transesophageal echocardiography (TEE). However, intra-procedural TEE monitoring could be difficult as some patients are intolerant. To compare safety and efficacy of guiding CA combined with LAAO by digital subtraction angiography (DSA) with or without TEE. From February 2019 to December 2020, 138 patients with non-valvular atrial fibrillation (AF) underwent CA combined with LAAO procedure were consecutively included, and two cohorts were built according to intra-procedural guidance (DSA or DSA with TEE). Periprocedural and follow-up outcomes were compared to investigate the feasibility and safety between the two cohorts. 71 patients and 67 patients were included in DSA cohort and TEE cohort respectively. Age and gender were comparable, despite TEE cohort has a higher proportion of persistent AF [37 (55.2%) VS 26 (36.6%)] and hemorrhage history [9 (13.4%) VS 0]. The procedure time of the DSA cohort was significantly reduced (95.7±27.6 min VS 108.9±30.3 min, P=0.018), with a non-significant longer fluoroscopic time (15.2±5.4 min vs 14.4±7.1 min, P=0.074) All combined procedure was performed successfully in both cohorts. And the overall incidence of peri-procedural complications were similar between cohorts. After an average of 24 months of clinical follow-up, only three patients in the TEE cohort had ≤ 3mm residual flow (P=0.232). Kaplan-Meier estimates showed non-significant differences between the cohorts for freedom from atrial arrhythmia (log-rank P value=0.964), major adverse cardiovascular events (log-rank P value=0.502) and other events. Compared with DSA and TEE guidance, DSA-guided combined procedure could shorten procedural time, while achieve similar periprocedural and long-term feasibility and safety.