Introduction
Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and leads to an increased risk of ischemic stroke as high as 5% per year.1 Despite the beneficial effect of catheter ablation in improving AF-induced symptoms, long-term sinus rhythm maintenance remains challenging.2 Furthermore, solid evidence of a proven role of AF catheter ablation in stroke prevention is lacking.3 The latest guideline does not recommend discontinuation of oral anticoagulation post-ablation in patients with high stroke risk.4
The left atrial appendage (LAA) is the main source of thrombi in patients with nonvalvular AF, and mechanical exclusion of the LAA has emerged as a nonpharmacologic approach for long-term stroke prevention.5 Thus, combining catheter ablation and LAA closure (LAAC) in a single procedure has been proposed as a promising therapeutic strategy for simultaneously alleviating symptoms and reducing the risk of thromboembolic or bleeding events..6,7 However, intraprocedural transesophageal echocardiography (TEE) guidance for device implantation is associated with a significant logistical burden, gastroesophageal damage, and risk associated with routine general anesthesia.8Intracardiac echocardiography (ICE) with the potential to overcome these shortcomings has therefore been performed as an alternative to TEE for LAAC.9,10 However, systemic assessment of LAA device deployment accompanied by AF ablation under ICE monitoring remains uncertain.
We aimed to report the outcomes and safety of ICE-guided LAAC within zero fluoroscopy radiofrequency catheter ablation procedure using a novel “FLAVOR” protocol with multi-angled imaging assessment.