Zero-contrast left atrial appendage closure, a feasible alternative for patients with a high risk of contrast-induced nephropathy: Systematic literature review and meta-analysis

BACKGROUND Left atrial appendage closure (LAAC) is an alternative to reduce thrombotic risk in patients with nonvalvular atrial fi brillation. This procedure conventionally requires the use of a contrast agent. A significant proportion of patients who undergo this procedure have chronic kidney disease, with a high risk of contrast-induced nephropathy. OBJECTIVE We aimed to systematically review existing literature regarding the feasibility and safety of a zero-contrast LAAC technique. METHODS We searched the MEDLINE/PubMed, Embase, and Cochrane Central Register of Controlled Trials databases for studies comparing a zero-contrast LAAC technique with conventional LAAC up to April 2024. From each study, we extracted baseline characteristics, feasibility, and safety outcomes. A random model meta-analysis was used to compare outcomes between groups. RESULTS Five studies reporting data from 367 patients were included. A 100% successful implantation rate was reported in all the zero-contrast groups. The mean number of recaptures reached no significant difference between the groups (mean difference,-0.15; CI,-0.67 to 0.37; I2 = 0%; P = . 58). The zero-contrast group had a significantly shorter fl uoroscopy time (mean difference,-4.03; CI,-7.72 to-0.34; I2 = 67%; P = . 03). Complications related to the procedure, peridevice leak, and device-associated thrombus rates were not significantly different between the groups. CONCLUSION Zero-contrast LAAC is a feasible alternative. The success and complication rates are consistent with those of conventional LAAC. Aside from the inherent benefit of zero-contrast exposure, this technique allows a reduction in fl uoroscopy time.