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.