Zero-Contrast Versus Contrast-Guided Left Atrial Appendage Occlusion: A Comparative Analysis of Procedural and Long-Term Outcomes.

BACKGROUND

Contrast 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.

OBJECTIVES

To compare the safety and efficacy of zero-contrast versus contrast-guided LAAO.

METHODS

All 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.

RESULTS

Procedural 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).

CONCLUSIONS

Zero-contrast LAAO is a safe, effective, and efficient alternative to contrast-guided implantation, with comparable procedural and clinical outcomes.