Safety and efficacy of “one-stop” interventional therapy for non-valvular atrial fibrillation under DSA/TEE guidance

Abstract Objective “One-stop” interventional therapy for non-valvular atrial fibrillation (NVAF) traditionally relies on transesophageal echocardiography (TEE) guidance, which carries limitations including anesthesia requirements and esophageal injury risks. Whether digital subtraction angiography (DSA) combined with transthoracic echocardiography (TTE) guidance can balance therapeutic efficacy with procedural simplification remains unclear. This study aims to compare the safety and efficacy of “one-stop” procedure for NVAF under different imaging guidance modalities. Methods Based on predefined inclusion and exclusion criteria, this retrospective cohort study was conducted on consecutive NVAF patients undergoing combined “one-stop” interventional therapy in Department of Cardiology of our hospital between August 1, 2014 and July 31, 2024. According to intraoperative guidance methods, they were divided into the DSA combined with TTE group (DSA group, n=77) and the DSA combined with TEE group (TEE group, n=209). Relevant clinical data of the patients were collected from the hospital big data intelligent platform medical record system, including gender, age, comorbidities, and results of TTE and TEE examinations. Postoperative follow-up included atrial fibrillation recurrence, stroke, bleeding, device-related thrombosis (DRT), cardiac tamponade, hospitalization due to heart failure, and cardiac death. The safety and efficacy of the “one-stop” procedure were compared between the 2 groups. Results There were 286 patients enrolled in this study, including 170 males and 116 females, with 77 in the DSA group and 209 in the TEE group. All patients completed at least 6 months of follow-up, with a mean duration of 36.49±14.26 months. No statistically significant differences were observed in baseline characteristics between the 2 groups (P>0.05). The DSA group demonstrated shorter mean procedural time (202.4±39.3 vs 214.1±33.4 min, P=0.013). The incidence of DRT was higher in the DSA group than in the TEE group (3.9% vs 1.4%), though the difference was not statistically significant (P=0.411). Atrial fibrillation recurrence occurred in 10 patients (13.0%) in the DSA group and 19 patients (9.1%) in the TEE group, with no significant intergroup difference. Regarding clinical endpoints, no significant differences were observed between the 2 groups in terms of stroke, major bleeding, cardiac tamponade, heart failure rehospitalization, or cardiac death. Kaplan-Meier survival curve analysis revealed no statistical differences between the 2 groups in composite endpoints, such as major adverse cardiovascular events (MACE), and in the efficacy composite endpoint, including atrial fibrillation recurrence, heart failure rehospitalization, stroke, or transient ischemic attack. Conclusion For NVAF patients undergoing one-stop procedures, DSA guidance can shorten procedural time and achieve comparable safety and efficacy to TEE guidance, with the exception of a trend toward increased DRT incidence. Keywords atrial fibrillation, “one-stop” interventional treatment, digital subtraction angiography, transesophageal echocardiography, left atrial appendage occlusion ,