Background: Left atrial appendage closure (LAAC) is an alternative to reduce thrombotic risk in patients with non-valvular atrial fibrillation. Conventionally this procedure requires the use of a contrast agent. A significant proportion of patients who underwent this procedure have chronic kidney disease, presenting a high risk of contrast-induced nephropathy.
Objective: We aimed to systematically review existing literature regarding the feasibility and safety of a zero-contrast LAAC technique.
Methods: We searched the MEDLINE/PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases for studies comparing a zero-contrast LAAC technique with conventional LAAC up to April 2024. From each study, we extracted baseline characteristics, feasibility, and safety outcomes. A random model meta-analysis was used to compare outcomes between groups.
Results: Five studies reporting data from 367 patients were included. A 100% successful implantation rate was reported in all the zero-contrast groups. The mean number of recaptures reached no significant difference between the groups (MD= -0.15 CI: -0.67 to 0.37 I2 = 0% p=0.58). The zero-contrast group presented a significantly shorter fluoroscopy time (MD = -4.03, CI: -7.72; -0.34, I2 =67%, P=0.03). Complications related to the procedure, peri-device leak, and device-associated thrombus rates were not significantly different among the groups.
Conclusion: Zero-contrast LAAC is a feasible alternative. The success and complication rates are consistent with those of conventional LAAC. Aside from the inherent benefit of zero-contrast exposure, this technique allows for a reduction in fluoroscopy time.
Keywords: Atrial Fibrillation; Chronic kidney disease; Contrast Agent; Fluoroscopy; Left atrial appendage closure.
Copyright © 2024. Published by Elsevier Inc.