Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure.

Autor: Jungen C; Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Zeus T; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Balzer J; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Eickholt C; Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Petersen M; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Kehmeier E; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Veulemans V; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Kelm M; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany., Willems S; Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany., Meyer C; Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2015 Oct 14; Vol. 10 (10), pp. e0140386. Date of Electronic Publication: 2015 Oct 14 (Print Publication: 2015).
DOI: 10.1371/journal.pone.0140386
Abstrakt: Aims: To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure.
Methods and Results: In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1±8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1±5.9 months) no device-related events occurred.
Conclusions: Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.
Trial Registration: ClinicalTrials.gov NCT01262508.
Databáze: MEDLINE
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