Aims 

We evaluated the feasibility of left atrial appendage (LAA) closure guided by the image fusion of integrating fluoroscopy into 3D computed tomography (CT).

Methods and results 

A total of 117 consecutive patients who underwent LAA closure with or without the image fusion were matched (1:2). Each LAA closure step of the Image fusion group was guided by the preprocedure CT and image fusion, especially in the plan of LAA measurement and transseptal puncture. All patients were successfully implanted with a WATCHMAN closure device. Comparing the two groups, the mean number of recapture times and the number of devices per patient of the Image fusion group were significantly lower (0.4 ± 0.5 vs. 0.7 ± 0.8, P = 0.031 and 1.0 ± 0.2 vs. 1.1 ± 0.3, P = 0.027, respectively). The one-time successful deployment rate by the support of the image fusion was higher than in the control group (66.7% vs. 44.9%, P = 0.026). Each case of the Image fusion group was completely occluded with one transseptal puncture, while five of the Non-image fusion group required redo transseptal punctures. During the 45-day follow-up, both group cases presented occlusion efficiency and no major adverse cardiac events were observed.

Conclusion 

Image fusion technique integrating fluoroscopy into the 3D CT is safe and feasible which can be easily incorporated into the procedural work-flow of percutaneous LAA closure. The fusion image can play an important alternative role in the plan of LAA measurement and transseptal puncture site for improving the LAA closure procedure.

中文翻译：

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将荧光透视法整合到3D计算机断层扫描中以指导左心耳闭合的图像融合

目的 

我们评估了将透视结合到3D计算机断层扫描（CT）中的图像融合指导左心耳（LAA）封闭的可行性。

方法与结果 

总共有117位连续患者接受了LAA封闭（有或没有图像融合）（1：2）。图像融合组的每个LAA闭合步骤均受到术前CT和图像融合的指导，尤其是在LAA测量和经房间隔穿刺的计划中。所有患者均成功植入WATCHMAN闭合装置。两组比较，图像融合组的平均重新捕获次数和每位患者的设备数量均显着降低（0.4±0.5 vs. 0.7±0.8，P = 0.031和1.0±0.2 vs. 1.1±0.3，P分别为0.027）。在图像融合的支持下，一次性成功部署率高于对照组（66.7％vs. 44.9％，P = 0.026）。影像融合组的每例病例均经一次隔隔穿刺完全闭塞，非图像融合组中有5个需要重做跨隔穿刺。在45天的随访期间，两组病例均表现出阻塞效率，未观察到重大的不良心脏事件。

结论 

将荧光检查技术集成到3D CT中的图像融合技术是安全可行的，可以很容易地纳入经皮LAA封闭的程序工作流程中。融合图像可以在LAA测量和经隔隔穿刺部位的计划中起到重要的替代作用，以改善LAA闭合过程。