Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging?

Abstract

Background

Real-time echocardiography-fluoroscopy fusion imaging (FI) merges real-time echocardiographic imaging with fluoroscopic images allowing intuitive anatomical spatial orientation during structural heart disease interventions. We aimed to assess the safety and efficacy of FI during percutaneous left atrial appendage closure (LAAC).

Methods

34 consecutive patients before (–FI) and 121 patients after (+FI) the introduction of FI for LAAC were included in a single-centre study. In-hospital safety parameters were analysed according to adverse event (AE) definition of the Munich consensus document and procedure-related parameters were assessed for efficacy. An ANCOVA was performed to investigate the influence of a learning curve.

Results

Time until successful transseptal puncture was significantly reduced as well as total procedure time and the amount of contrast agent used (+FI/–FI:17 ± 6.35 min vs. 22 ± 8.33 min, p = 0.001; +FI/–FI: 50 min IQR 43 min − 60 min vs. 57 min IQR 45 min −70 min; p = 0.013; +FI/–FI: 70 mL, IQR 55 ml–90 mL vs. 152 mL, IQR 107 mL − 205 mL; p < 0.001). However, fluoroscopy time and dose-area product did not differ between both groups. There was no significant difference in the occurrence of in-hospital adverse events (+FI/–FI: 2.5% vs. 0%; p = 0.596). The ANCOVA revealed that the learning curve does not affect procedural efficacy parameters such as procedure time, time to transseptal puncture, amount of contrast agent and dose-area product.

Conclusions

FI for LAAC reduces the total procedure time, the time to successful transseptal puncture and periprocedural amount of contrast agent.

Keywords:

• Echo-Fluoro fusion imaging
• EchoNavigator
• left atrial appendage closure
• periinterventional imaging

Disclosure statement

Shazia Afzal, Amin Polzin and Tobias Zeus have received honoraria for lectures from Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The University Hospital Düsseldorf and Philips Healthcare have a master research agreement. Philips was consulted for technical issues only and had no influence in design, analysis or interpretation of this study.

Additional information

Funding

This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Duesseldorf with funding for Clinician Scientist Track [No 2019-15 to SA, No. 2018-32 to GW].