{"paper_id":"40bfc539-7f54-4d99-8673-95613e4faf81","body_text":"Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study Yang Luo, Bin Gao, Xutang Qin, Yan Wang, Jinlei Yin, Bin Li, Yujie Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3499375/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Assessing the Efficacy, Safety, and Economic Analysis of Transcatheter Closure of Left Atrial Appendage with Guidance of Perspective Directing Catheter Ablation Procedure. Methods The study included patients with non-valvular atrial fibrillation who were admitted to the Seventh People's Hospital, Zhengzhou City, and underwent catheter ablation from March 2017 to April 2022. These patients were divided into two groups, the transesophageal echocardiography combined with fluoroscopy group (TEE group, n = 73) and the fluoroscopy-guided group (DSA group, n = 73), using propensity score matching. Perioperative and follow-up data were compared to assess the efficacy, safety and cost-effectiveness of fluoroscopy-guided left atrial appendage closure combined with catheter ablation. Results Both groups of patients successfully completed catheter ablation and left atrial appendage occlusion, with similar procedure times ( P > 0.05), indicating no statistical difference. In total, 4 patients experienced pericardial effusion and 1 patient experienced vagal reflex ( P > 0.05), but there were no statistically significant differences. Regarding the occurrence of minimal pericardial effusion, there was a statistically significant difference between the DSA group and the TEE group ( P < 0.05), suggesting that the DSA group may have an advantage. Additionally, there were statistically significant differences between the DSA group and the TEE group in terms of hospitalization period and expenses ( P < 0.05). During the follow-up period, there were no statistically significant differences between the two groups in terms of atrial fibrillation recurrence, re-ablation, stroke/transient ischemic attack, and embolism. There were also no statistically significant differences in terms of all-cause mortality, all-cause rehospitalization, cardiovascular event rehospitalization, and major bleeding. Likewise, there were no statistically significant differences in terms of device displacement, residual shunting related to the device, and device-related thrombosis. Conclusions For the left atrial appendage occlusion combined with catheter ablation, the effectiveness and safety of DSA alone are not inferior to DSA combined with TEE guidance, and it has certain advantages in reducing hospital costs and length of stay. Catheter ablation Left atrial appendage occlusion digital subtraction angiography Propensity score matching Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Atrial fibrillation (AF) is the prevailing cardiac arrhythmia encountered in clinical settings, and its frequency and occurrence in China continue to escalate annually. Notably, a substantial number of at least 6.9 million individuals in China are afflicted with AF, thereby presenting an immense public health predicament[ 1 ]. AF is associated with an increased risk of stroke and transient ischemic attack, and the majority of fatal blood clots have been shown to originate in the left atrium (LAA), so prevention of thromboembolism in patients with AF is essential[ 2 ]. On the other hand, according to the 2020 ESC AF guidelines, all patients with symptomatic AF should receive rhythm control therapy (IA), with strategies including antiarrhythmic drugs and catheter ablation, and the use of catheter ablation is recommended for pharmacologically refractory AF[ 3 , 4 ]. Left atrial appendage occlusion (LAAO) combined with catheter ablation (CA) offers a new way of thinking about the treatment of atrial fibrillation, from a single procedure to an improved prognosis, Karen P et al. reported on a multi-center retrospective study of 142 patients who underwent LAAO combined with CA in a single procedure with a 2-year follow-up, demonstrating its long-term safety and efficacy[ 5 ]. A meta-analysis of 18 studies also confirmed the safety and effectiveness of the one-stop procedure[ 6 ]. Standard LAAO requires transesophageal echocardiography (TEE)-guided deployment of the amplatzer under general anesthesia [ 7 ]. However, with experience and progress, the standard procedure increases the risk of general anesthesia and oesophageal injury, as well as the patient's hospital stay and cost. Numerous studies have elucidated the safety and effectiveness of LAAO solely employing digital subtraction angiography (DSA)[ 8 – 10 ]. Presently, there exists a lack of comparable outcomes for the solitary application of DSA contrasted with the concurrent utilization of DSA alongside TEE-guided LAAO in combination with CA. The safety, efficacy, and cost-effectiveness of two surgical strategies were examined in the current study using propensity score matching (PSM) as the analytical approach. METHODS Study population : The present study retrospectively collected data on patients with non-valvular atrial fibrillation who were admitted to the Seventh People's Hospital of Zhengzhou City and underwent catheter ablation from March 2017 to April 2022. In accordance with the surgical approach, a comprehensive repository was established to include all individuals who underwent the combined procedure of LAAO and CA. Subsequently, the patients were segregated into two distinct cohorts: the TEE group, denoting those who received guidance from both DSA and Transesophageal Echocardiography (TEE); and the DSA group, representing individuals who solely relied on DSA guidance during the procedure.(Fig. 1 ) Inclusion criteria: (1) diagnosis of paroxysmal or persistent AF confirmed by surface electrocardiogram or 24-hour ambulatory electrocardiogram; (2) indications for CA: Including symptomatic AF refractory to at least one antiarrhythmic drug, a strong personal desire to convert to sinus rhythm, and voluntary acceptance of CA; (3) CHA2DS2-VASc score of ≥ 2 in men and ≥ 3 in women and/or HAS-BLED score of ≥ 3; and (4) All ablations were radiofrequency ablations and blockers were selected from the Watchman TM blocker. Exclusion criteria: (1) Atrial fibrillation caused by valvular heart disease or hyperthyroidism; (2) Left atrial diameter measured by transthoracic echocardiography(TTE) > 50mm; (3) Presence of thrombus in the left atrium or left atrial appendage confirmed by transesophageal echocardiography(TEE) or computed tomography angiography (CTA); (4) History of hemorrhagic or ischemic stroke within 30 days; (5) Uncontrolled heart failure or severe liver or kidney dysfunction; (6) Life expectancy less than 1 year; (7) Active bleeding disorders; (8) Patients scheduled for other surgeries during this hospitalization; (9) Missing clinical data. Each patient was fully informed of the risks and complications of surgery and signed an informed consent form. The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Zhengzhou Seventh People's Hospital. Preprocedural preparation : Pre-operative demographic data (basic information, physical examination, vital signs) were recorded, and relevant blood markers, such as routine blood tests, liver and kidney functions, electrolytes, coagulation, markers of myocardial injury, N-terminal B-type natriuretic peptide, etc., as well as chest x-rays or CT and TTE were performed to clarify the presence of abnormal structures. CTA or TEE was used to exclude thrombus, and LAA morphology and left auricular diameter, depth, and internal and external orifice size were also assessed. Pre-operative anticoagulation: patients on new oral anticoagulants should maintain their current anticoagulation regimen; patients on oral warfarin should have their international normalized ratio (INR) checked and maintained at 2.0–3.0. In patients not on anticoagulation, subcutaneous injection of low molecular weight heparin (see weight dosing). In addition, anticoagulants should be discontinued for 24 hours prior to surgery in all patients. Surgical operations : Procedural conditions: All patients underwent transcatheter AF catheter ablation using radiofrequency energy in the Cath Lab under the guidance of the Carto 3D electroanatomic system (Boston Scientific Corporation) and percutaneous LAAO using the Watchman blocker under the guidance of DSA in combination with TEE or alone. The anesthetic protocol encompassed the utilization of local anesthetic for the DSA group, while general anesthetic was administered for the TEE group. In cases where patients were unable to tolerate TEE, they were given the option to be transferred to the DSA group. AF ablation: Bilateral pulmonary vein electrical isolation (PVI) was performed for paroxysmal AF and single-loop isolation rates were recorded. Posteriorly, ablation of non-pulmonary vein-triggered foci is performed, and individualize left atrial matrix modification strategies are also required in patients with non-paroxysmal atrial fibrillation. Electrical isolation of the LAA is feasible in patients with clear trigger foci in the LAA. Check for bidirectional conduction block in the bilateral pulmonary veins and in each ablation line. To restore sinus rhythm in cases of spontaneous or induced atrial fibrillation during the procedure, when ablation or intravenous antiarrhythmic drugs such as amiodarone or eplerenone are unsuccessful, synchronized direct current resuscitation was administered. LAAO procedure was conducted subsequent to the completion of CA. To ensure precision and safety, the occluder delivery sheath was introduced into the left atrial appendage (LAA) under the supervision and protection of a pigtail catheter, and the accurate positioning of the sheath was verified through DSA. The pigtail catheter is retracted, subsequently followed by the introduction of a preloaded Watchman blocker, and the securing of the delivery sheath to the introducer sheath. During the process of DSA or TEE surveillance, the TEE group carefully examines the morphology of the left auricle from different perspectives, specifically at 0°, 45°, 90°, and 135° angles, before releasing the blocker. On the other hand, the DSA group compares the left auricle using at least two orthogonal projection angles. It is generally recommended to use the right anterior oblique (RAO) 30° + 20° in the foot position (CAU), or RAO 30° + 20° in the cephalic position (CRAN). Additionally, if necessary, a combination of 20° in CAU and/or 20° in CRAN can be used. According to the findings from the LAA contrast analysis, measurements were taken on the maximum diameter of the LAA mouth and the effective working depth at various projection positions. The deployment of the self-expanding occluder entails securing the handle and performing a sheath withdrawal procedure. Finally, The DSA was employed to validate both the occluder's placement and the existence of a notable marginal shunt. The compression ratio was determined at the occluder's greatest lateral diameter, while the occluder's stability was verified through a pull test. (Fig. 2 ) Postprocedural management and follow-up : Anticoagulation regimen in the post-operative period was routinely determined: (1) anticoagulants (including warfarin or new oral anticoagulants) were taken for the first 3 months post-operatively; (2) no LAAO-related events occurred in the first 3 months post-operatively: device-related thrombosis (DRT), device-related residual shunt (peri-device leak, PDL) greater than 5 mm, occluder displacement, etc. then discontinue anticoagulation therapy and switch to dual antiplatelet therapy with aspirin and clopidogrel tablets, and then switch to lifelong single antiplatelet therapy, i.e. aspirin or clopidogrel tablets, at 6 months post-operatively; and (3) if relevant LAAO occlusion-related events occur, then extend the duration of oral anticoagulants, re-evaluate TEE/CTA after 3 months and decide on further management strategy. The patients were closely monitored in an outpatient setting at regular intervals of 1, 3, 6, and 12 months after the surgery. During these follow-up appointments, their vital signs and medical history were documented, and various diagnostic tests such as Transthoracic Echocardiography (TTE), Electrocardiogram (ECG), and in cases where TTE was not feasible, telephone follow-up were conducted to assess the patient's clinical progress. At the 3-month mark, Transesophageal Echocardiography (TEE) or Computed Tomography Angiography (CTA) was performed to evaluate the condition of left ventricular (LV) block and to identify any events associated with LV block. Additionally, a 24-hour ambulatory electrocardiogram was conducted every six months to evaluate the effectiveness of the treatment. The primary events observed in this clinical trial encompassed the recurrence of atrial fibrillation (AF), with the initial three-month period designated as a blanking period wherein AF episodes were not regarded as recurrences. Additionally, occurrences of ischemic stroke were also monitored. Secondary outcomes evaluated included cardiac mortality, rehospitalization for any cause, rehospitalization related to cardiovascular issues, major instances of bleeding, reablation procedures, events associated with LAAO, hospitalizations, and the associated costs. Statistical analysis: Statistical analyses were performed using SPSS 25.0 (IBM SPSS Statistics) software. A propensity-y score-matched analysis was done using a multivariable logistic regression model based on:age,gender,BMI,AFtype,CHA2DS2-VAScscore,HAS-BLED score, N-terminal pro-BNP, creatinine, Urea nitrogen, alanine aminotransferase, aspartate aminotransferase, hematocrit, Left atrial diameter, left ventricular ejection fraction, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke history, Hemorrhage history. Pair of 104, patients were derived using 1:1 greedy nearest neighbor matching within PS score of 0.01. This strategy resulted in 73 matched pairs in each group. Measurement data that follow a normal distribution are described using the mean ± standard deviation (x ± s), while non-normal measurement data are described using Md (P25, P75); count data are de-scribed using frequency and percentage. Before PSM, independent sample t-test and Mann-Whitney U test were used for continuous data, chi-square test and Fisher's exact probability test were used for categorical data. After PSM, paired sample t-test and Wilcoxon rank-sum test were used for continuous data, and McNemar test was used for categorical data.For survival analysis, Kaplan-Meier estimation was used to analyze the P-values obtained through the log-rank test for atrial fibrillation recurrence, all-cause hospitalization, cardiovascular readmission, and all-cause mortality. Two-sided p < 0.05 was considered significant for all analyses. RESULTS Baseline data : This study included a cohort of 244 patients who underwent combined CA and LAAO. After performing PSM, a total of 73 pairs were successfully matched, comprising the DSA group (n = 73, mean age: 67.4 ± 9.4, 40 males) and the TEE group (n = 73, mean age: 65.1 ± 11.0, 42 males). There were statistical differences in the proportion of patients with persistent AF [DSA: 86 (82.7%), TEE: 87 (62.1%), P < 0.05] and Hemorrhage history [DSA: 1 (1.0%), TEE: 9 (6. 4%), P < 0.05] between the two groups before PSM, whereas age,gender,BMI,CHA2DS2-VAScscore,HAS-BLED score, N-terminal pro-BNP, creatinine, Urea nitrogen, alanine aminotransferase, aspartate aminotransferase, hematocrit, Left atrial diameter, left ventricular ejection fraction, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke history showed no statistically significant differences, and the baseline information of the two groups was basically balanced after PSM, as detailed in Table 1 . Table 1 PSM pre- and post-baseline Parameters Pre-PSM Post PSM Overall( N = 244) DSA( N = 104) TEE( N = 140) P Overall( N = 146) DSA( N = 73) TEE( N = 73) P Age,years 66.2 ± 10.2 66.0 ± 10.0 66.2 ± 10.3 0.910 66.2 ± 10.2 67.4 ± 9.4 65.1 ± 11.0 0.180 Gender(male),n(%) 134(54.9%) 57(54.8%) 77(55.0%) 0.976 82(56.2%) 40(54.8%) 42(57.5) 0.878 BMI(kg/m2) 25.3 ± 3.7 24.8 ± 3.9 25.7 ± 3.6 0.080 25.1 ± 3.7 24.8 ± 3.6 25.3 ± 3.8 0.401 AF type(persAF),n(%) 173(70.9%) 86(82.7%) 87(62.1%) 0.0008 * 118(80.8%) 57(78.1%) 61(83.6%) 0.388 CHA 2 DS 2 -VASc score 4.0(3.0,5.0) 4.0(3.0,5.0) 4.0(3.0,5.0) 0.628 4(3,5) 4(3,5) 4(3,5) 0.583 HAS-BLED score 2.0(2.0,3.0) 2.0(2.0,3.0) 2.0(2.0,3.0) 0.463 2.5(2,3) 2(2,3) 3(2,3) 0.877 NT-probnp,pg/mL 678.3(432.5,1030.8) 678.0(346.0,1030.8) 682.8(463.7,1035.9) 0.330 693.0(449.2,1061.8) 688.7(375.0,1044.7) 740.0(460.0,740.0) 0.893 Cre,umol/L 65.0(54.0,77.0) 64.0(53.0,75.8) 64.0(54.0,80.0) 0.592 65.0(55.8,77.0) 65(57.0,77.0) 64.0(54.0,79.0) 0.686 Urea nitrogen,mmol/L 5.5(4.6,7.3) 5.5(4.5,7.5) 5.6(4.7,7.2) 0.588 5.5(4.7,7.4) 5.9(4.8,7.5) 5.3(4.6,7.3) 0.093 ALT,U/L 23.0(16.0,37.0) 21.0(15.0,35.8) 24.5(17.6,37.8) 0.289 22.5(15.0,35.3) 22.0(15.0,35.5) 23.0(14.5,34.5) 0.931 AST,U/L 24.5(19.0,34.8) 24.0(20.0,32.5) 25.0(19.0,35.0) 0.999 25.0(20.0,32.3) 26.0(20.5,34.0) 24.0(19.0,32.0) 0.534 HCT,‰ 4.2 ± 0.5 4.1 ± 0.6 4.2 ± 0.5 0.900 4.1 ± 0.05 4.2 ± 0.06 4.2 ± 0.05 0.956 LAD,mm 40.9 ± 5.8 40.7 ± 5.5 41.1 ± 6.1 0.543 40.9 ± 5.6 40.9 ± 5.6 40.8 ± 5.6 0.928 LVEF,% 58.0(54.0,63.0) 58.0(54.0,63.0) 58.0(54.0,63.0) 0.772 57.8 ± 6.5 57.9 ± 6.5 58.0 ± 6.5 0.721 Hypertension,n(%) 144(59.0%) 57(54.8%) 87(62.1%) 0.249 78(53.4%) 40(54.8%) 38(52.1%) 0.868 Diabetes mellitus,n(%) 55(22.5%) 23(22.1%) 32(22.9%) 0.891 27(18.5%) 17(23.3%) 10(13.7%) 0.248 CHD,n(%) 96(39.3%) 35(33.7%) 61(43.6%) 0.117 55(37.7%) 28(38.4%) 27(37.0%) 1.000 Heart failure,n(%) 86(35.2%) 33(31.7%) 53(37.9%) 0.322 48(32.9%) 27(37.0%) 21(28.8%) 0.418 Stroke history,n(%) 58(23.8%) 24(23.1%) 34(24.3%) 0.826 37(25.3%) 17(23.3%) 20(27.4%) 0.701 Hemorrhage history,n(%) 10(4.1%) 1(1.0%) 9(6.4%) 0.033 * 2(1.4%) 1(1.4%) 1(1.4%) 1.000 Note:In statistical data, the mean ± SD is used to represent data that follows a normal distribution, while the median (upper quartile, lower quartile) is used to represent data that does not follow a normal distribution. Count data is represented using percentages (%). Statistical analysis is conducted using independent samples before PSM, while paired samples are used for statistical analysis after PSM. The asterisk (*) represents statistical significance. Abbreviation:BMI,body mass index;persAF,persistent atrial fibrillation;ProBNP,N-terminal pro-BNP;Cre,creatinine;ALT,alanine aminotransferase;AST,aspartate aminotransferase;HCT,hematocrit;LAD,Left atrial diameter;LVEF,left ventricular ejection fraction;CHD, coronary heart disease. The results during the perioperative period and before discharge : Two groups of patients successfully completed CA and LAAO, with similar procedural duration (DSA: 244.3 ± 65.1, TEE: 233.3 ± 62.0, P > 0.05). There were no statistically significant differences in left atrial appendage morphology, selected occluder size, or intraoperative electrical cardioversion between the two groups. Four patients developed pericardial tamponade [DSA: 1(1.4%), TEE: 3(4.1%), P > 0.05] and recovered after emergency pericardial puncture drainage and were discharged. One patient in the DSA group (1.4%, P > 0.05) experienced a vagal reflex and recovered after receiving dopamine and atropine. However, the DSA group had fewer cases of small pericardial effusion [DSA: 6(8.2%), TEE: 15(20.5%), P < 0.05], indicating a statistical difference. During the hospitalization period, the DSA group had a significantly reduced length of stay compared to the TEE group (DSA: 9.3 ± 2.6, TEE: 10.5 ± 2.7, P < 0.05). There was also a difference in hospitalization expenses (DSA: 146028.1 ± 12481.1, TEE: 156517.7 ± 13271.2, P < 0.05), both of which had statistical significance. Please refer to Table 2 for more details. Table 2 Evaluation of perioperative safety and efficacy, as well as inpatient economic benefits Parameters Overall( N = 146) DSA( N = 73) TEE( N = 73) P Procedural Duration,min 238.8 ± 63.6 244.3 ± 65.1 233.3 ± 62.0 0.299 Left atrial appendage morphology,n(%) 0.801 Chicken Wing 33(22.6%) 14(19.2%) 19(26.0%) Cactus 19(13.0%) 10(13.7%) 9(12.3%) Windsock 32(21.9%) 17(23.3%) 15(20.5%) Cauliflower 62(42.5%) 32(43.8%) 30(41.2%) Occluder Size(plug),mm 27(24,30) 27(24,30) 27(24,30) 0.141 Successful Closure,n(%) 146(100) 73(100) 73(100) - Intraoperative electrical Cardioversion,n(%) 67(45.9%) 35(47.9%) 32(43.8%) 0.618 Safety evaluation Vagal reflex,n(%) 1(0.7%) 1(1.4%) 0 1.000 Phrenic nerve palsy,n(%) 0 0 0 - PDL,n(%) 0 0 0 - Pericardial Effusion,n(%) Small amount 21(14.4%) 6(8.2%) 15(20.5%) 0.034 * Pericardial Tamponade 4(2.7%) 1(1.4%) 3(4.1%) 0.620 Postoperative anticoagulant,n(%) 1.000 Rivaroxaban 120(82.2%) 60(82.2%) 60(82.2%) Dabigatran 21(14.4%) 11(15.1%) 10(13.7%) Warfarin 5(3.4%) 2(2.7%) 3(4.1%) Hospitalization period,day 9.9 ± 2.7 9.3 ± 2.6 10.5 ± 2.7 0.006 * Hospitalization Expenses,rmb 151272.9 ± 13874.6 146028.1 ± 12481.1 156517.7 ± 13271.2 0.000 * Follow-up results : A total of 8 patients were lost to follow-up during the follow-up period. In terms of efficacy, the two groups of patients showed similar results in terms of AF recurrence [DSA: 7 (10.9%), TEE: 8 (11.0%), P > 0.05] and number of redo ablations [DSA: 2 (3.1%), TEE: 3 (4.1%), P > 0.05]. No stroke/TIA or systemic thrombosis was observed in either group. In the safety evaluation, there was one case (1.4%, P > 0.05) of patient mortality due to acute myocardial infarction in the TEE group. There were also two cases (2.7%, P > 0.05) of major bleeding events, one case of cerebral hemorrhage and one case of gastrointestinal bleeding. The two groups were also similar in terms of all-cause prehospitalization [DSA: 13 (20%), TEE group: 17 (23.3%), P > 0.05] and cardiovascular event prehospitalization [DSA: 10 (15.4%), TEE group: 14 (19.2%), P > 0.05], with no statistically significant difference. A total of 115 (83.3%) patients completed the follow-up of TEE/CTA [DSA: 52 (80.0%), TEE: 63 (86.3%), P > 0.05]. Four patients (3.5%, P > 0.05) experienced PDL ranging from 3-5mm, which significantly decreased to less than 3mm upon reexamination of TEE/CTA after six months. In the DSA group, three cases (5.8%, P > 0.05) developed DRT, which disappeared significantly after prolonging the duration of oral anticoagulant therapy. Please refer to Table 3 for more details. According to Fig. 3 , the Kaplan-Meier estimation shows no statistically significant differences in AF recurrence ( P = 0.962), all-cause hospitalization ( P = 0.593), cardiovascular readmission ( P = 0.567), and all-cause death ( P = 0.345). Table 3 Follow-up safety and efficacy evaluation. Events Overall( N = 138) DSA( N = 65) TEE( N = 73) P Efficacy evaluation AF recurrence,n(%) 15/138(10.9%) 7/65(10.8%) 8/73(11.0%) 0.971 Redo-ablation,n(%) 5/138(3.1%) 2/65(3.1%) 3/73(4.1%) 1.000 Stroke/TIA, n(%) 0 0 0 - Systemic thrombosis, n(%) 0 0 0 - Safety evaluation All-cause death, n(%) 1/138(0.7%) 0 1/73(1.4%) 1.000 Rehospitalization due to all disease, n(%) 30/138(21.7%) 13/65(20.0%) 17/73(23.3%) 0.640 Rehospitalization due to cardiovascular disease, n(%) 24/138(17.4%) 10/65(15.4%) 14/73(19.2%) 0.557 Major hemorrhage, n(%) 2/138(1.4%) 0 2/73(2.7%) 0.498 TEE/CTA follow-up Completed, n(%) 115/138(83.3%) 52/65(80.0%) 63/73(86.3%) 0.321 TEE 84/115(73.0%) 34/52(65.4%) 18/63(34.6%) CTA 31/115(27.0%) 50/52(79.4%) 13/63(20.6%) Displacement, n (%) 0 0 0 - PDL, n(%) 0.512 ≤ 3mm 28/115(24.3%) 10/52(19.2%) 18/63(28.6%) 3 ~ 5mm 4/115(3.5%) 2/52(3.8%) 2/63(3.2%) ≥ 5mm 0 0 0 DRT, n(%) 3/115(2.6%) 3/52(5.8%) 0 0.090 Abbreviations:TIA,transient ischemic attack; DISCUSSION In this study, a total of 146 patients were included. Through PSM, the two groups were stabilized in terms of baseline characteristics, ensuring comparability between the groups. First, the perioperative and follow-up results showed that the efficacy and safety of DSA alone guiding LAAO combined with CA were not inferior to DSA combined with TEE guiding LAAO combined with CA, and even superior to the TEE group in terms of the occurrence of a small amount of pericardial effusion during surgery. Furthermore, by retrospectively collecting two sets of hospitalization duration and hospitalization expenses, it was found that the DSA group had a shorter hospital stay and lower costs compared to the TEE group. The standard method for guiding LAAO is TEE guidance under general anaesthesia [ 11 ]. While intraoperative transesophageal echocardiography (TEE) is generally regarded as safe, it is important to acknowledge that there are potential risks associated with this procedure. Studies have reported complications in the range of 0.2–1.2%, with a subset of these complications being severe enough to pose a threat to the patient's life[ 12 ]. The use of TEE for LAAO is not usually prolonged, but the majority of patients undergoing this procedure have a history of bleeding, which increases the risk of TEE-related complications[ 13 ]. Ammar A et al. retrospectively collected data from 3042 patients undergoing LAAO, and found that 8.61% of patients experienced major complications, which may be attributed to direct mechanical damage to the esophagus caused by forced manipulation while the patient was under general anesthesia and unable to swallow the probe. This also suggests that general anesthesia imposes additional limitations on the standard procedure[ 14 ]. The utilization of DSA without the need for general anesthesia to facilitate LAAO represents a novel approach in the field. Guérios documented the initial application of DSA as the sole guiding technique for LAAO, involving a cohort of 76 individuals, which yielded an impressive success rate of 99%[ 15 ]. A scientific study by Yuniadi et al. compared the simplified and standardized formats in terms of small-sample, medium- to long-term follow-up. The results showed that there were no statistically significant differences in stroke and mortality between the two groups over an average follow-up of 75 weeks[ 9 ]. Previous studies typically only consider the time required for left atrial appendage occlusion. In our study, we compared the overall surgical time of two groups, which is similar to the results of Karen P[ 16 ]. In the study, a total of 67 patients (45.9%) underwent electrical cardioversion and did not undergo further ablation after successful restoration of normal sinus rhythm[ 17 ]. In their scholarly publication, Yuki et al. conducted a study involving a cohort of 128 patients afflicted with persistent atrial fibrillation. The research findings suggest that in cases where atrial fibrillation persists following scheduled ablation, intra-atrial electrical cardioversion can be utilized as an effective alternative. Moreover, the study posits that successful termination of atrial fibrillation through this method may obviate the need for additional extensive ablation procedures to achieve termination[ 17 ]. Pericardial tamponade is a serious complication that can occur during the perioperative phase of LAAO. Numerous studies have shown that the incidence of pericardial tamponade with TEE-guided left atrial occlusion seals ranges from 0.5–2.0%[ 18 – 22 ]. In comparison, DSA-guided pericardial tamponade alone ranges from 1.1–1.9%, with no statistically significant difference observed between the two approaches. These results are in line with our own investigation[ 9 , 15 , 23 ]. Previous studies have not performed a separate analysis of the economic impact between the simplified and standard styles. Our results show that the DSA group had shorter hospital stays and lower hospital costs. This may be due to the fact that patients could be transferred to the general ward immediately after surgery. Furthermore, these patients were able to leave their beds within 8–12 hours of surgery without any surgical complications, resulting in a significantly accelerated recovery process and reduced hospital costs. However, it is important to note that further multi-center validation is required to substantiate these findings. A total of 15 (10.9%) patients had a recurrence during the 1-year follow-up period in this study, while 5 (3.1%) had another CA. After CA, the recurrence of AF has become common in clinical practice. The mechanism of recurrence may involve the reestablishment of isolated pulmonary vein electrical signals and the development of atrial fibrosis[ 24 ]. Up to 35% of patients require repeat ablation procedures, with a higher proportion observed in patients with persistent atrial fibrillation[ 25 ]. There is also research indicating that the use of cryoballoon ablation may be more effective in reducing the recurrence of arrhythmias[ 26 , 27 ]. PDL and DRT are recognized complications of LAAO. In certain patients, peri-device leakage is expected either during initial implantation or during subsequent follow-up. This leakage is attributed to the geometry mismatch between the occluder and the LAA.[ 28 ] There is also a risk of thrombus formation until the device is fully endothelialised[ 29 ]. Previous studies have considered a PDL measurement of less than 3mm as the threshold for insignificance[ 30 , 31 ]. In this study, a total of 28 patients (24.3%) were found to have a PDL measurement of ≤ 3mm during follow-up, while 4 patients (3.5%) had a PDL measurement of 3-5mm. The potential harm of such minor PDL measurements remains inconclusive[ 32 ]. Furthermore, we have also found that 3 patients developed DRT, with one patient discontinuing anticoagulant medication on their own within one week after surgery. On the basis of intensified anticoagulation, all 3 (2.6%) patients had their DRT disappear during the follow-up TEE examination at 3–6 months. According to a recent meta-analysis of 66 studies, the incidence of DRT was 3.8%, which is similar to our results, so a standardized anticoagulation programmes is essential[ 33 ]. This study is a retrospective analysis from a single center. Although PSM was used, it is important to acknowledge the potential for bias. Furthermore, due to the limited sample size and the exclusion of some patients who did not undergo TEE or CTA, the full association between these complications and surgical interventions could not be demonstrated. In addition, the follow-up of some patients was based on telephone interviews conducted at a later stage, which may have missed people with asymptomatic TIA. To ensure more accurate and reliable results, a more refined study design for subsequent validation during the follow-up period is essential. CONCLUSIONS In conclusion, the efficacy and safety of using DSA guidance alone for LAAO combined with CA is comparable to that of combining DSA with TEE guidance. In addition, the use of DSA guidance alone offers certain advantages in terms of cost reduction and shorter hospital stays. Declarations Author contribution Yang Luo and Gao Bin drafted the manuscript and organised the data, Qin Xu-tan, Li Bin and Yin Jin-lei collected the data, Wang Yan provided financial support, and Zhao Yujie revised and reviewed the manuscript. Funding This work was supported by Henan Natural Science Foundation (212300410305) Data availability The datasets used and/or analyzed during the current study is available from the corresponding author on reasonable request. Ethical approval and consent to participate Not applicable. Consent for publication Not applicable. Conflict of interest The authors declare no competing interests. References Bergau L, Bengel P, Sciacca V, Fink T, Sohns C, Sommer P.2022. Atrial Fibrillation and Heart Failure. J Clin Med 11. https://doi.ore/10.3390/jcm11092510 Bizhanov KA, Аbzaliyev KB, Baimbetov AK, Sarsenbayeva AB, Lyan E.2023. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). J Cardiovasc Electrophysiol 34:153-165. https://doi.ore/10.1111/jce.15759 Anonymous.2021. Corrigendum to: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 42:546-547. https://doi.ore/10.1093/eurheartj/ehaa945 Rohrer U, Manninger M, Zirlik A, Scherr D.2022. Impact of Catheter Ablation for Atrial Fibrillation on Quality of Life. J Clin Med 11. https://doi.ore/10.3390/jcm11154541 Phillips KP, Romanov A, Artemenko S, Folkeringa RJ, Szili-Torok T, Senatore G, Stein KM, Razali O, Gordon N, Boersma LVA.2020. Combining left atrial appendage closure and catheter ablation for atrial fibrillation: 2-year outcomes from a multinational registry. Europace 22:225-231. https://doi.ore/10.1093/europace/euz286 Qu J, Wang Z, Wang S.2022. Effect of catheter ablation combined with left appendage occlusion for non-valvular atrial fibrillation: a meta-analysis. J Cardiothorac Surg 17:132. https://doi.ore/10.1186/s13019-022-01885-9 Kavinsky CJ, Kusumoto FM, Bavry AA, Bailey SR, Ellenbogen KA, Hess PL, Lustgarten DL, Moussa ID, Spies C.2016. SCAI/ACC/HRS institutional and operator requirements for left atrial appendage occlusion. Catheter Cardiovasc Interv 87:351-62. https://doi.ore/10.1002/ccd.26381 Meng W, Li X, Ren Z, Zheng Y, Zhang J, Yang H, Guo R, Li H, Zhang J, Wang Y, Jia P, Zhao D, Xu Y.2023. Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes. Clin Cardiol 46:549-557. https://doi.ore/10.1002/clc.23993 Yuniadi Y, Hanafy DA, Raharjo SB, Yugo D.2019. Left atrial appendage closure device implantation guided with fluoroscopy only: Long-term results. J Arrhythm 35:262-266. https://doi.ore/10.1002/joa3.12151 So CY, Lam YY, Cheung GS, Chan CKY, Chen S, Chan AK, Park JW, Schmidt B, Yan BP.2018. Minimalistic Approach to Left Atrial Appendage Occlusion Using the LAmbre Device. JACC Cardiovasc Interv 11:1113-1114. https://doi.ore/10.1016/j.jcin.2018.01.275 Wolfes J, Ellermann C, Frommeyer G, Eckardt L.2022. Evidence-based treatment of atrial fibrillation around the globe: comparison of the latest ESC, AHA/ACC/HRS, and CCS guidelines on the management of atrial fibrillation. Rev Cardiovasc Med 23:56. https://doi.ore/10.31083/j.rcm2302056 Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L, Beaudoin J, O'Connor K, Turgeon PY, Paradis JM, Ferreira-Neto A, Asmarats L, Champagne J, O'Hara G, Bernier M.2020. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J 221:19-28. https://doi.ore/10.1016/j.ahj.2019.11.018 Freeman JV, Varosy P, Price MJ, Slotwiner D, Kusumoto FM, Rammohan C, Kavinsky CJ, Turi ZG, Akar J, Koutras C, Curtis JP, Masoudi FA.2020. The NCDR Left Atrial Appendage Occlusion Registry. J Am Coll Cardiol 75:1503-1518. https://doi.ore/10.1016/j.jacc.2019.12.040 Hasnie AA, Parcha V, Hawi R, Trump M, Shetty NS, Ahmed MI, Booker OJ, Arora P, Arora G.2023. Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions. J Am Soc Echocardiogr 36:381-390. https://doi.ore/10.1016/j.echo.2022.12.023 Guérios EE, Schmid M, Gloekler S, Khattab AA, Wenaweser PM, Windecker S, Meier B.2012. Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation. Arq Bras Cardiol 98:528-36. https://doi.ore/10.1590/s0066-782x2012005000044 Phillips KP, Walker DT, Humphries JA.2016. Combined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures: Five-year experience. J Arrhythm 32:119-26. https://doi.ore/10.1016/j.joa.2015.11.001 Komatsu Y, Uno K, Otomo K, Nagata Y, Taniguchi H, Ogura K, Egami Y, Takayama K, Kakita K, Iesaka Y.2011. Atrial defibrillation threshold as a novel predictor of clinical outcome of catheter ablation for persistent atrial fibrillation. Europace 13:213-20. https://doi.ore/10.1093/europace/euq357 Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S.2011. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 123:417-24. https://doi.ore/10.1161/circulationaha.110.976449 Reddy VY, Gibson DN, Kar S, O'Neill W, Doshi SK, Horton RP, Buchbinder M, Gordon NT, Holmes DR.2017. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol 69:253-261. https://doi.ore/10.1016/j.jacc.2016.10.010 Lam YY, Yip GW, Yu CM, Chan WW, Cheng BC, Yan BP, Clugston R, Yong G, Gattorna T, Paul V.2012. Left atrial appendage closure with AMPLATZER cardiac plug for stroke prevention in atrial fibrillation: initial Asia-Pacific experience. Catheter Cardiovasc Interv 79:794-800. https://doi.ore/10.1002/ccd.23136 Phillips KP, Santoso T, Sanders P, Alison J, Chan JLK, Pak HN, Chandavimol M, Stein KM, Gordon N, Razali OB.2019. Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry. Int J Cardiol Heart Vasc 23:100358. https://doi.ore/10.1016/j.ijcha.2019.100358 Sievert H, Lesh MD, Trepels T, Omran H, Bartorelli A, Della Bella P, Nakai T, Reisman M, DiMario C, Block P, Kramer P, Fleschenberg D, Krumsdorf U, Scherer D.2002. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation 105:1887-9. https://doi.ore/10.1161/01.cir.0000015698.54752.6d Yang L, Zhang X, Jin Q, Kong D, Zhang Y, Li M, Zhang L, Chen S, Pan W, Zhou D, Ge J.2021. Pericardial Effusion During the Perioperative Period for Left Atrial Appendage Closure. Front Cardiovasc Med 8:678460. https://doi.ore/10.3389/fcvm.2021.678460 Erhard N, Metzner A, Fink T.2022. Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications. Herzschrittmacherther Elektrophysiol 33:71-76. https://doi.ore/10.1007/s00399-021-00836-6 Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, et al.2017. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14:e275-e444. https://doi.ore/10.1016/j.hrthm.2017.05.012 Andrade JG, Khairy P, Guerra PG, Deyell MW, Rivard L, Macle L, Thibault B, Talajic M, Roy D, Dubuc M.2011. Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 8:1444-51. https://doi.ore/10.1016/j.hrthm.2011.03.050 Kuck KH, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KR, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque JP, Tondo C.2016. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 374:2235-45. https://doi.ore/10.1056/NEJMoa1602014 Saw J, Tzikas A, Shakir S, Gafoor S, Omran H, Nielsen-Kudsk JE, Kefer J, Aminian A, Berti S, Santoro G, Nietlispach F, Moschovitis A, Cruz-Gonzalez I, Stammen F, Tichelbäcker T, Freixa X, Ibrahim R, Schillinger W, Meier B, Sievert H, Gloekler S.2017. Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure With the Amplatzer Cardiac Plug. JACC Cardiovasc Interv 10:391-399. https://doi.ore/10.1016/j.jcin.2016.11.029 Wunderlich NC, Lorch GC, Honold J, Franke J, Küx H.2020. Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them. Curr Cardiol Rep 22:113. https://doi.ore/10.1007/s11886-020-01357-3 Ostermayer SH, Reisman M, Kramer PH, Matthews RV, Gray WA, Block PC, Omran H, Bartorelli AL, Della Bella P, Di Mario C, Pappone C, Casale PN, Moses JW, Poppas A, Williams DO, Meier B, Skanes A, Teirstein PS, Lesh MD, Nakai T, Bayard Y, Billinger K, Trepels T, Krumsdorf U, Sievert H.2005. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol 46:9-14. https://doi.ore/10.1016/j.jacc.2005.03.042 Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P.2009. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534-42. https://doi.ore/10.1016/s0140-6736(09)61343-x Sleiman JR, Lewis AJ, Perez EJ, Sanchez AM, Baez-Escudero JL, Navia JL, Asher CR, Cubeddu RJ.2021. Management of peri-device leak following left atrial appendage closure: A systematic review. Catheter Cardiovasc Interv 98:382-390. https://doi.ore/10.1002/ccd.29495 Alkhouli M, Busu T, Shah K, Osman M, Alqahtani F, Raybuck B.2018. Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion: A Meta-Analysis. JACC Clin Electrophysiol 4:1629-1637. https://doi.ore/10.1016/j.jacep.2018.09.007 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3499375\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":243548993,\"identity\":\"4ba18206-e654-48e9-89ab-787880bdef63\",\"order_by\":0,\"name\":\"Yang Luo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Xinxiang Medica University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yang\",\"middleName\":\"\",\"lastName\":\"Luo\",\"suffix\":\"\"},{\"id\":243548994,\"identity\":\"727caf9e-26cc-4098-9122-0324cfaac641\",\"order_by\":1,\"name\":\"Bin 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13:59:12\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3499375/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3499375/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":45485929,\"identity\":\"84bcbaad-6490-4fc0-ad37-2b0b3148e7ee\",\"added_by\":\"auto\",\"created_at\":\"2023-10-30 21:52:01\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":355751,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eShows a flow chart of the entire experiment.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3499375/v1/5c8381df9d8da0438e966541.png\"},{\"id\":45485928,\"identity\":\"41d2b3b3-f40b-41e8-bb1f-d203a61a7c4b\",\"added_by\":\"auto\",\"created_at\":\"2023-10-30 21:52:01\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":118329,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTwo positions commonly used during blocking are demonstrated.RAO: the right anterior oblique;CAU: the foot position.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3499375/v1/32ba26c313014007261034a0.jpeg\"},{\"id\":45485927,\"identity\":\"b3dfcbbc-2769-4fdd-b77d-0b844d7821f0\",\"added_by\":\"auto\",\"created_at\":\"2023-10-30 21:52:01\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":92223,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eA:Survival analysis of AF recurrence;B:Survival analysis of all-cause death;Survival analysis of all-cause hospitalization;Survival analysis of cardiovascular readmission.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinefloatimage3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3499375/v1/d0a140b24f692f0d0c9de59e.png\"},{\"id\":45884178,\"identity\":\"bc52bd05-2a75-420f-86ae-7ffd4b2cf7f4\",\"added_by\":\"auto\",\"created_at\":\"2023-11-05 11:07:23\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":878368,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3499375/v1/588d5d80-5482-40ba-b4fb-9ad8d7c28256.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eAtrial fibrillation (AF) is the prevailing cardiac arrhythmia encountered in clinical settings, and its frequency and occurrence in China continue to escalate annually. Notably, a substantial number of at least 6.9\\u0026nbsp;million individuals in China are afflicted with AF, thereby presenting an immense public health predicament[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. AF is associated with an increased risk of stroke and transient ischemic attack, and the majority of fatal blood clots have been shown to originate in the left atrium (LAA), so prevention of thromboembolism in patients with AF is essential[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. On the other hand, according to the 2020 ESC AF guidelines, all patients with symptomatic AF should receive rhythm control therapy (IA), with strategies including antiarrhythmic drugs and catheter ablation, and the use of catheter ablation is recommended for pharmacologically refractory AF[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Left atrial appendage occlusion (LAAO) combined with catheter ablation (CA) offers a new way of thinking about the treatment of atrial fibrillation, from a single procedure to an improved prognosis, Karen P et al. reported on a multi-center retrospective study of 142 patients who underwent LAAO combined with CA in a single procedure with a 2-year follow-up, demonstrating its long-term safety and efficacy[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. A meta-analysis of 18 studies also confirmed the safety and effectiveness of the one-stop procedure[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Standard LAAO requires transesophageal echocardiography (TEE)-guided deployment of the amplatzer under general anesthesia [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. However, with experience and progress, the standard procedure increases the risk of general anesthesia and oesophageal injury, as well as the patient's hospital stay and cost. Numerous studies have elucidated the safety and effectiveness of LAAO solely employing digital subtraction angiography (DSA)[\\u003cspan additionalcitationids=\\\"CR9\\\" citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Presently, there exists a lack of comparable outcomes for the solitary application of DSA contrasted with the concurrent utilization of DSA alongside TEE-guided LAAO in combination with CA. The safety, efficacy, and cost-effectiveness of two surgical strategies were examined in the current study using propensity score matching (PSM) as the analytical approach.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eStudy population\\u003c/b\\u003e: The present study retrospectively collected data on patients with non-valvular atrial fibrillation who were admitted to the Seventh People's Hospital of Zhengzhou City and underwent catheter ablation from March 2017 to April 2022. In accordance with the surgical approach, a comprehensive repository was established to include all individuals who underwent the combined procedure of LAAO and CA. Subsequently, the patients were segregated into two distinct cohorts: the TEE group, denoting those who received guidance from both DSA and Transesophageal Echocardiography (TEE); and the DSA group, representing individuals who solely relied on DSA guidance during the procedure.(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) Inclusion criteria: (1) diagnosis of paroxysmal or persistent AF confirmed by surface electrocardiogram or 24-hour ambulatory electrocardiogram; (2) indications for CA: Including symptomatic AF refractory to at least one antiarrhythmic drug, a strong personal desire to convert to sinus rhythm, and voluntary acceptance of CA; (3) CHA2DS2-VASc score of \\u0026ge;\\u0026thinsp;2 in men and \\u0026ge;\\u0026thinsp;3 in women and/or HAS-BLED score of \\u0026ge;\\u0026thinsp;3; and (4) All ablations were radiofrequency ablations and blockers were selected from the Watchman \\u003csup\\u003eTM\\u003c/sup\\u003e blocker. Exclusion criteria: (1) Atrial fibrillation caused by valvular heart disease or hyperthyroidism; (2) Left atrial diameter measured by transthoracic echocardiography(TTE)\\u0026thinsp;\\u0026gt;\\u0026thinsp;50mm; (3) Presence of thrombus in the left atrium or left atrial appendage confirmed by transesophageal echocardiography(TEE) or computed tomography angiography (CTA); (4) History of hemorrhagic or ischemic stroke within 30 days; (5) Uncontrolled heart failure or severe liver or kidney dysfunction; (6) Life expectancy less than 1 year; (7) Active bleeding disorders; (8) Patients scheduled for other surgeries during this hospitalization; (9) Missing clinical data. Each patient was fully informed of the risks and complications of surgery and signed an informed consent form. The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Zhengzhou Seventh People's Hospital.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003ePreprocedural preparation\\u003c/b\\u003e: Pre-operative demographic data (basic information, physical examination, vital signs) were recorded, and relevant blood markers, such as routine blood tests, liver and kidney functions, electrolytes, coagulation, markers of myocardial injury, N-terminal B-type natriuretic peptide, etc., as well as chest x-rays or CT and TTE were performed to clarify the presence of abnormal structures. CTA or TEE was used to exclude thrombus, and LAA morphology and left auricular diameter, depth, and internal and external orifice size were also assessed. Pre-operative anticoagulation: patients on new oral anticoagulants should maintain their current anticoagulation regimen; patients on oral warfarin should have their international normalized ratio (INR) checked and maintained at 2.0\\u0026ndash;3.0. In patients not on anticoagulation, subcutaneous injection of low molecular weight heparin (see weight dosing). In addition, anticoagulants should be discontinued for 24 hours prior to surgery in all patients.\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003eSurgical operations\\u003c/b\\u003e: Procedural conditions: All patients underwent transcatheter AF catheter ablation using radiofrequency energy in the Cath Lab under the guidance of the Carto 3D electroanatomic system (Boston Scientific Corporation) and percutaneous LAAO using the Watchman blocker under the guidance of DSA in combination with TEE or alone. The anesthetic protocol encompassed the utilization of local anesthetic for the DSA group, while general anesthetic was administered for the TEE group. In cases where patients were unable to tolerate TEE, they were given the option to be transferred to the DSA group. AF ablation: Bilateral pulmonary vein electrical isolation (PVI) was performed for paroxysmal AF and single-loop isolation rates were recorded. Posteriorly, ablation of non-pulmonary vein-triggered foci is performed, and individualize left atrial matrix modification strategies are also required in patients with non-paroxysmal atrial fibrillation. Electrical isolation of the LAA is feasible in patients with clear trigger foci in the LAA. Check for bidirectional conduction block in the bilateral pulmonary veins and in each ablation line. To restore sinus rhythm in cases of spontaneous or induced atrial fibrillation during the procedure, when ablation or intravenous antiarrhythmic drugs such as amiodarone or eplerenone are unsuccessful, synchronized direct current resuscitation was administered. LAAO procedure was conducted subsequent to the completion of CA. To ensure precision and safety, the occluder delivery sheath was introduced into the left atrial appendage (LAA) under the supervision and protection of a pigtail catheter, and the accurate positioning of the sheath was verified through DSA. The pigtail catheter is retracted, subsequently followed by the introduction of a preloaded Watchman blocker, and the securing of the delivery sheath to the introducer sheath. During the process of DSA or TEE surveillance, the TEE group carefully examines the morphology of the left auricle from different perspectives, specifically at 0\\u0026deg;, 45\\u0026deg;, 90\\u0026deg;, and 135\\u0026deg; angles, before releasing the blocker. On the other hand, the DSA group compares the left auricle using at least two orthogonal projection angles. It is generally recommended to use the right anterior oblique (RAO) 30\\u0026deg; + 20\\u0026deg; in the foot position (CAU), or RAO 30\\u0026deg; + 20\\u0026deg; in the cephalic position (CRAN). Additionally, if necessary, a combination of 20\\u0026deg; in CAU and/or 20\\u0026deg; in CRAN can be used. According to the findings from the LAA contrast analysis, measurements were taken on the maximum diameter of the LAA mouth and the effective working depth at various projection positions. The deployment of the self-expanding occluder entails securing the handle and performing a sheath withdrawal procedure. Finally, The DSA was employed to validate both the occluder's placement and the existence of a notable marginal shunt. The compression ratio was determined at the occluder's greatest lateral diameter, while the occluder's stability was verified through a pull test. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003ePostprocedural management and follow-up\\u003c/b\\u003e: Anticoagulation regimen in the post-operative period was routinely determined: (1) anticoagulants (including warfarin or new oral anticoagulants) were taken for the first 3 months post-operatively; (2) no LAAO-related events occurred in the first 3 months post-operatively: device-related thrombosis (DRT), device-related residual shunt (peri-device leak, PDL) greater than 5 mm, occluder displacement, etc. then discontinue anticoagulation therapy and switch to dual antiplatelet therapy with aspirin and clopidogrel tablets, and then switch to lifelong single antiplatelet therapy, i.e. aspirin or clopidogrel tablets, at 6 months post-operatively; and (3) if relevant LAAO occlusion-related events occur, then extend the duration of oral anticoagulants, re-evaluate TEE/CTA after 3 months and decide on further management strategy. The patients were closely monitored in an outpatient setting at regular intervals of 1, 3, 6, and 12 months after the surgery. During these follow-up appointments, their vital signs and medical history were documented, and various diagnostic tests such as Transthoracic Echocardiography (TTE), Electrocardiogram (ECG), and in cases where TTE was not feasible, telephone follow-up were conducted to assess the patient's clinical progress. At the 3-month mark, Transesophageal Echocardiography (TEE) or Computed Tomography Angiography (CTA) was performed to evaluate the condition of left ventricular (LV) block and to identify any events associated with LV block. Additionally, a 24-hour ambulatory electrocardiogram was conducted every six months to evaluate the effectiveness of the treatment. The primary events observed in this clinical trial encompassed the recurrence of atrial fibrillation (AF), with the initial three-month period designated as a blanking period wherein AF episodes were not regarded as recurrences. Additionally, occurrences of ischemic stroke were also monitored. Secondary outcomes evaluated included cardiac mortality, rehospitalization for any cause, rehospitalization related to cardiovascular issues, major instances of bleeding, reablation procedures, events associated with LAAO, hospitalizations, and the associated costs.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis:\\u003c/h2\\u003e \\u003cp\\u003eStatistical analyses were performed using SPSS 25.0 (IBM SPSS Statistics) software. A propensity-y score-matched analysis was done using a multivariable logistic regression model based on:age,gender,BMI,AFtype,CHA2DS2-VAScscore,HAS-BLED score, N-terminal pro-BNP, creatinine, Urea nitrogen, alanine aminotransferase, aspartate aminotransferase, hematocrit, Left atrial diameter, left ventricular ejection fraction, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke history, Hemorrhage history. Pair of 104, patients were derived using 1:1 greedy nearest neighbor matching within PS score of 0.01. This strategy resulted in 73 matched pairs in each group. Measurement data that follow a normal distribution are described using the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (x\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;s), while non-normal measurement data are described using Md (P25, P75); count data are de-scribed using frequency and percentage. Before PSM, independent sample t-test and Mann-Whitney U test were used for continuous data, chi-square test and Fisher's exact probability test were used for categorical data. After PSM, paired sample t-test and Wilcoxon rank-sum test were used for continuous data, and McNemar test was used for categorical data.For survival analysis, Kaplan-Meier estimation was used to analyze the P-values obtained through the log-rank test for atrial fibrillation recurrence, all-cause hospitalization, cardiovascular readmission, and all-cause mortality. Two-sided \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered significant for all analyses.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003e \\u003cb\\u003eBaseline data\\u003c/b\\u003e: This study included a cohort of 244 patients who underwent combined CA and LAAO. After performing PSM, a total of 73 pairs were successfully matched, comprising the DSA group (n\\u0026thinsp;=\\u0026thinsp;73, mean age: 67.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.4, 40 males) and the TEE group (n\\u0026thinsp;=\\u0026thinsp;73, mean age: 65.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.0, 42 males). There were statistical differences in the proportion of patients with persistent AF [DSA: 86 (82.7%), TEE: 87 (62.1%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05] and Hemorrhage history [DSA: 1 (1.0%), TEE: 9 (6. 4%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05] between the two groups before PSM, whereas age,gender,BMI,CHA2DS2-VAScscore,HAS-BLED score, N-terminal pro-BNP, creatinine, Urea nitrogen, alanine aminotransferase, aspartate aminotransferase, hematocrit, Left atrial diameter, left ventricular ejection fraction, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke history showed no statistically significant differences, and the baseline information of the two groups was basically balanced after PSM, as detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePSM pre- and post-baseline\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"9\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eParameters\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003ePre-PSM\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c8\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003ePost PSM\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverall(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;244)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDSA(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;104)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTEE(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;140)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eOverall(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;146)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eDSA(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;73)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTEE(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;73)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge,years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e66.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e66.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e66.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.910\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e66.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e67.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e65.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.180\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender(male),n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e134(54.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e57(54.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e77(55.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.976\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e82(56.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e40(54.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e42(57.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.878\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI(kg/m2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e25.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.080\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e25.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e24.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e25.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.401\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAF type(persAF),n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e173(70.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e86(82.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87(62.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.0008\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e*\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e118(80.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e57(78.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e61(83.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.388\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.0(3.0,5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.0(3.0,5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.0(3.0,5.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.628\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4(3,5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e4(3,5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e4(3,5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.583\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHAS-BLED score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.0(2.0,3.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.0(2.0,3.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.0(2.0,3.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.463\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.5(2,3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2(2,3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e3(2,3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.877\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNT-probnp,pg/mL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e678.3(432.5,1030.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e678.0(346.0,1030.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e682.8(463.7,1035.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.330\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e693.0(449.2,1061.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e688.7(375.0,1044.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e740.0(460.0,740.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.893\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCre,umol/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e65.0(54.0,77.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64.0(53.0,75.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e64.0(54.0,80.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.592\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e65.0(55.8,77.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e65(57.0,77.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e64.0(54.0,79.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.686\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUrea nitrogen,mmol/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.5(4.6,7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.5(4.5,7.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5.6(4.7,7.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.588\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5.5(4.7,7.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.9(4.8,7.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e5.3(4.6,7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.093\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eALT,U/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.0(16.0,37.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21.0(15.0,35.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.5(17.6,37.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.289\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e22.5(15.0,35.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e22.0(15.0,35.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e23.0(14.5,34.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.931\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAST,U/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24.5(19.0,34.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.0(20.0,32.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e25.0(19.0,35.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.999\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e25.0(20.0,32.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e26.0(20.5,34.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e24.0(19.0,32.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.534\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHCT,\\u0026permil;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.900\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e4.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e4.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.956\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLAD,mm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e41.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.543\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e40.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e40.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e40.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.928\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLVEF,%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58.0(54.0,63.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e58.0(54.0,63.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e58.0(54.0,63.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.772\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e57.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e57.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e58.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.721\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e144(59.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e57(54.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87(62.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.249\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e78(53.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e40(54.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e38(52.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.868\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetes mellitus,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e55(22.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23(22.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e32(22.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.891\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e27(18.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e17(23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e10(13.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.248\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCHD,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e96(39.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35(33.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e61(43.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.117\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e55(37.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e28(38.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e27(37.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHeart failure,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e86(35.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33(31.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53(37.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.322\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e48(32.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e27(37.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e21(28.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.418\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStroke history,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58(23.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24(23.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34(24.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.826\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e37(25.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e17(23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e20(27.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.701\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHemorrhage history,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10(4.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(1.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(6.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.033\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e*\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003eNote:In statistical data, the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD is used to represent data that follows a normal distribution, while the median (upper quartile, lower quartile) is used to represent data that does not follow a normal distribution. Count data is represented using percentages (%). Statistical analysis is conducted using independent samples before PSM, while paired samples are used for statistical analysis after PSM. The asterisk (*) represents statistical significance.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003eAbbreviation:BMI,body mass index;persAF,persistent atrial fibrillation;ProBNP,N-terminal pro-BNP;Cre,creatinine;ALT,alanine aminotransferase;AST,aspartate\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003eaminotransferase;HCT,hematocrit;LAD,Left atrial diameter;LVEF,left ventricular ejection fraction;CHD, coronary heart disease.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eThe results during the perioperative period and before discharge\\u003c/b\\u003e: Two groups of patients successfully completed CA and LAAO, with similar procedural duration (DSA: 244.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;65.1, TEE: 233.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;62.0, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). There were no statistically significant differences in left atrial appendage morphology, selected occluder size, or intraoperative electrical cardioversion between the two groups. Four patients developed pericardial tamponade [DSA: 1(1.4%), TEE: 3(4.1%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05] and recovered after emergency pericardial puncture drainage and were discharged. One patient in the DSA group (1.4%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) experienced a vagal reflex and recovered after receiving dopamine and atropine. However, the DSA group had fewer cases of small pericardial effusion [DSA: 6(8.2%), TEE: 15(20.5%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05], indicating a statistical difference. During the hospitalization period, the DSA group had a significantly reduced length of stay compared to the TEE group (DSA: 9.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.6, TEE: 10.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). There was also a difference in hospitalization expenses (DSA: 146028.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12481.1, TEE: 156517.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13271.2, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), both of which had statistical significance. Please refer to Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e for more details.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eEvaluation of perioperative safety and efficacy, as well as inpatient economic benefits\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParameters\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverall(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;146)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDSA(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;73)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTEE(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;73)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProcedural Duration,min\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e238.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;63.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e244.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;65.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e233.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;62.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.299\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLeft atrial appendage morphology,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.801\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eChicken Wing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33(22.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19(26.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCactus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19(13.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(13.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(12.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWindsock\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32(21.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(20.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCauliflower\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62(42.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e32(43.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30(41.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOccluder Size(plug),mm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27(24,30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(24,30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27(24,30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.141\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSuccessful Closure,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e146(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e73(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e73(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntraoperative electrical Cardioversion,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e67(45.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35(47.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e32(43.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.618\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSafety evaluation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVagal reflex,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(0.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhrenic nerve palsy,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePDL,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePericardial Effusion,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSmall amount\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21(14.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(8.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(20.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.034\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e*\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePericardial Tamponade\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(2.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(4.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.620\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePostoperative anticoagulant,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRivaroxaban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e120(82.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60(82.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e60(82.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDabigatran\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21(14.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(15.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(13.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWarfarin\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(3.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(2.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(4.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHospitalization period,day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.006\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e*\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHospitalization Expenses,rmb\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e151272.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13874.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e146028.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12481.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e156517.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13271.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.000\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003e*\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eFollow-up results\\u003c/b\\u003e: A total of 8 patients were lost to follow-up during the follow-up period. In terms of efficacy, the two groups of patients showed similar results in terms of AF recurrence [DSA: 7 (10.9%), TEE: 8 (11.0%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05] and number of redo ablations [DSA: 2 (3.1%), TEE: 3 (4.1%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05]. No stroke/TIA or systemic thrombosis was observed in either group. In the safety evaluation, there was one case (1.4%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) of patient mortality due to acute myocardial infarction in the TEE group. There were also two cases (2.7%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) of major bleeding events, one case of cerebral hemorrhage and one case of gastrointestinal bleeding. The two groups were also similar in terms of all-cause prehospitalization [DSA: 13 (20%), TEE group: 17 (23.3%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05] and cardiovascular event prehospitalization [DSA: 10 (15.4%), TEE group: 14 (19.2%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05], with no statistically significant difference. A total of 115 (83.3%) patients completed the follow-up of TEE/CTA [DSA: 52 (80.0%), TEE: 63 (86.3%), \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05]. Four patients (3.5%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) experienced PDL ranging from 3-5mm, which significantly decreased to less than 3mm upon reexamination of TEE/CTA after six months. In the DSA group, three cases (5.8%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) developed DRT, which disappeared significantly after prolonging the duration of oral anticoagulant therapy. Please refer to Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e for more details. According to Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, the Kaplan-Meier estimation shows no statistically significant differences in AF recurrence (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.962), all-cause hospitalization (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.593), cardiovascular readmission (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.567), and all-cause death (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.345).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eFollow-up safety and efficacy evaluation.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEvents\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverall(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;138)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDSA(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;65)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTEE(\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;73)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEfficacy evaluation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAF recurrence,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15/138(10.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7/65(10.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8/73(11.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.971\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRedo-ablation,n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5/138(3.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2/65(3.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3/73(4.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStroke/TIA, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSystemic thrombosis, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSafety evaluation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAll-cause death, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1/138(0.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1/73(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRehospitalization due to all disease, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30/138(21.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13/65(20.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17/73(23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.640\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRehospitalization due to cardiovascular\\u003c/p\\u003e \\u003cp\\u003edisease, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24/138(17.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10/65(15.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14/73(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.557\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMajor hemorrhage, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2/138(1.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2/73(2.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.498\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTEE/CTA follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompleted, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e115/138(83.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52/65(80.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e63/73(86.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.321\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTEE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e84/115(73.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34/52(65.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18/63(34.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCTA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e31/115(27.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e50/52(79.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13/63(20.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDisplacement, n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePDL, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.512\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;3mm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28/115(24.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10/52(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18/63(28.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e3\\u0026thinsp;~\\u0026thinsp;5mm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4/115(3.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2/52(3.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2/63(3.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;5mm\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDRT, n(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3/115(2.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3/52(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.090\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eAbbreviations:TIA,transient ischemic attack;\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eIn this study, a total of 146 patients were included. Through PSM, the two groups were stabilized in terms of baseline characteristics, ensuring comparability between the groups. First, the perioperative and follow-up results showed that the efficacy and safety of DSA alone guiding LAAO combined with CA were not inferior to DSA combined with TEE guiding LAAO combined with CA, and even superior to the TEE group in terms of the occurrence of a small amount of pericardial effusion during surgery. Furthermore, by retrospectively collecting two sets of hospitalization duration and hospitalization expenses, it was found that the DSA group had a shorter hospital stay and lower costs compared to the TEE group.\\u003c/p\\u003e \\u003cp\\u003eThe standard method for guiding LAAO is TEE guidance under general anaesthesia [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. While intraoperative transesophageal echocardiography (TEE) is generally regarded as safe, it is important to acknowledge that there are potential risks associated with this procedure. Studies have reported complications in the range of 0.2\\u0026ndash;1.2%, with a subset of these complications being severe enough to pose a threat to the patient's life[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. The use of TEE for LAAO is not usually prolonged, but the majority of patients undergoing this procedure have a history of bleeding, which increases the risk of TEE-related complications[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Ammar A et al. retrospectively collected data from 3042 patients undergoing LAAO, and found that 8.61% of patients experienced major complications, which may be attributed to direct mechanical damage to the esophagus caused by forced manipulation while the patient was under general anesthesia and unable to swallow the probe. This also suggests that general anesthesia imposes additional limitations on the standard procedure[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The utilization of DSA without the need for general anesthesia to facilitate LAAO represents a novel approach in the field. Gu\\u0026eacute;rios documented the initial application of DSA as the sole guiding technique for LAAO, involving a cohort of 76 individuals, which yielded an impressive success rate of 99%[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. A scientific study by Yuniadi et al. compared the simplified and standardized formats in terms of small-sample, medium- to long-term follow-up. The results showed that there were no statistically significant differences in stroke and mortality between the two groups over an average follow-up of 75 weeks[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePrevious studies typically only consider the time required for left atrial appendage occlusion. In our study, we compared the overall surgical time of two groups, which is similar to the results of Karen P[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. In the study, a total of 67 patients (45.9%) underwent electrical cardioversion and did not undergo further ablation after successful restoration of normal sinus rhythm[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In their scholarly publication, Yuki et al. conducted a study involving a cohort of 128 patients afflicted with persistent atrial fibrillation. The research findings suggest that in cases where atrial fibrillation persists following scheduled ablation, intra-atrial electrical cardioversion can be utilized as an effective alternative. Moreover, the study posits that successful termination of atrial fibrillation through this method may obviate the need for additional extensive ablation procedures to achieve termination[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Pericardial tamponade is a serious complication that can occur during the perioperative phase of LAAO. Numerous studies have shown that the incidence of pericardial tamponade with TEE-guided left atrial occlusion seals ranges from 0.5\\u0026ndash;2.0%[\\u003cspan additionalcitationids=\\\"CR19 CR20 CR21\\\" citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. In comparison, DSA-guided pericardial tamponade alone ranges from 1.1\\u0026ndash;1.9%, with no statistically significant difference observed between the two approaches. These results are in line with our own investigation[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Previous studies have not performed a separate analysis of the economic impact between the simplified and standard styles. Our results show that the DSA group had shorter hospital stays and lower hospital costs. This may be due to the fact that patients could be transferred to the general ward immediately after surgery. Furthermore, these patients were able to leave their beds within 8\\u0026ndash;12 hours of surgery without any surgical complications, resulting in a significantly accelerated recovery process and reduced hospital costs. However, it is important to note that further multi-center validation is required to substantiate these findings.\\u003c/p\\u003e \\u003cp\\u003eA total of 15 (10.9%) patients had a recurrence during the 1-year follow-up period in this study, while 5 (3.1%) had another CA. After CA, the recurrence of AF has become common in clinical practice. The mechanism of recurrence may involve the reestablishment of isolated pulmonary vein electrical signals and the development of atrial fibrosis[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Up to 35% of patients require repeat ablation procedures, with a higher proportion observed in patients with persistent atrial fibrillation[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. There is also research indicating that the use of cryoballoon ablation may be more effective in reducing the recurrence of arrhythmias[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. PDL and DRT are recognized complications of LAAO. In certain patients, peri-device leakage is expected either during initial implantation or during subsequent follow-up. This leakage is attributed to the geometry mismatch between the occluder and the LAA.[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e] There is also a risk of thrombus formation until the device is fully endothelialised[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Previous studies have considered a PDL measurement of less than 3mm as the threshold for insignificance[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. In this study, a total of 28 patients (24.3%) were found to have a PDL measurement of \\u0026le;\\u0026thinsp;3mm during follow-up, while 4 patients (3.5%) had a PDL measurement of 3-5mm. The potential harm of such minor PDL measurements remains inconclusive[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. Furthermore, we have also found that 3 patients developed DRT, with one patient discontinuing anticoagulant medication on their own within one week after surgery. On the basis of intensified anticoagulation, all 3 (2.6%) patients had their DRT disappear during the follow-up TEE examination at 3\\u0026ndash;6 months. According to a recent meta-analysis of 66 studies, the incidence of DRT was 3.8%, which is similar to our results, so a standardized anticoagulation programmes is essential[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study is a retrospective analysis from a single center. Although PSM was used, it is important to acknowledge the potential for bias. Furthermore, due to the limited sample size and the exclusion of some patients who did not undergo TEE or CTA, the full association between these complications and surgical interventions could not be demonstrated. In addition, the follow-up of some patients was based on telephone interviews conducted at a later stage, which may have missed people with asymptomatic TIA. To ensure more accurate and reliable results, a more refined study design for subsequent validation during the follow-up period is essential.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSIONS\",\"content\":\"\\u003cp\\u003eIn conclusion, the efficacy and safety of using DSA guidance alone for LAAO combined with CA is comparable to that of combining DSA with TEE guidance. In addition, the use of DSA guidance alone offers certain advantages in terms of cost reduction and shorter hospital stays.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAuthor contribution\\u003c/strong\\u003e\\u0026nbsp; Yang Luo and Gao Bin drafted the manuscript and organised the data, Qin Xu-tan, Li Bin and Yin Jin-lei collected the data, Wang Yan provided financial support, and Zhao Yujie revised and reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u0026nbsp; This work was supported by Henan Natural Science Foundation (212300410305)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability \\u0026nbsp;\\u003c/strong\\u003eThe datasets used and/or analyzed during the current study is available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical approval and consent to participate\\u003c/strong\\u003e\\u0026nbsp; Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication \\u0026nbsp;\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of interest \\u0026nbsp;\\u003c/strong\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eBergau L, Bengel P, Sciacca V, Fink T, Sohns C, Sommer P.2022. 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J Clin Med 11. https://doi.ore/10.3390/jcm11154541\\u003c/li\\u003e\\n\\u003cli\\u003ePhillips KP, Romanov A, Artemenko S, Folkeringa RJ, Szili-Torok T, Senatore G, Stein KM, Razali O, Gordon N, Boersma LVA.2020. Combining left atrial appendage closure and catheter ablation for atrial fibrillation: 2-year outcomes from a multinational registry. Europace 22:225-231. https://doi.ore/10.1093/europace/euz286\\u003c/li\\u003e\\n\\u003cli\\u003eQu J, Wang Z, Wang S.2022. Effect of catheter ablation combined with left appendage occlusion for non-valvular atrial fibrillation: a meta-analysis. J Cardiothorac Surg 17:132. https://doi.ore/10.1186/s13019-022-01885-9\\u003c/li\\u003e\\n\\u003cli\\u003eKavinsky CJ, Kusumoto FM, Bavry AA, Bailey SR, Ellenbogen KA, Hess PL, Lustgarten DL, Moussa ID, Spies C.2016. SCAI/ACC/HRS institutional and operator requirements for left atrial appendage occlusion. Catheter Cardiovasc Interv 87:351-62. https://doi.ore/10.1002/ccd.26381\\u003c/li\\u003e\\n\\u003cli\\u003eMeng W, Li X, Ren Z, Zheng Y, Zhang J, Yang H, Guo R, Li H, Zhang J, Wang Y, Jia P, Zhao D, Xu Y.2023. Guiding atrial fibrillation ablation combined with left atrial appendage occlusion procedure by fluoroscopy with or without transesophageal echocardiography achieved comparable outcomes. Clin Cardiol 46:549-557. https://doi.ore/10.1002/clc.23993\\u003c/li\\u003e\\n\\u003cli\\u003eYuniadi Y, Hanafy DA, Raharjo SB, Yugo D.2019. Left atrial appendage closure device implantation guided with fluoroscopy only: Long-term results. J Arrhythm 35:262-266. https://doi.ore/10.1002/joa3.12151\\u003c/li\\u003e\\n\\u003cli\\u003eSo CY, Lam YY, Cheung GS, Chan CKY, Chen S, Chan AK, Park JW, Schmidt B, Yan BP.2018. Minimalistic Approach to Left Atrial Appendage Occlusion Using the LAmbre Device. JACC Cardiovasc Interv 11:1113-1114. https://doi.ore/10.1016/j.jcin.2018.01.275\\u003c/li\\u003e\\n\\u003cli\\u003eWolfes J, Ellermann C, Frommeyer G, Eckardt L.2022. Evidence-based treatment of atrial fibrillation around the globe: comparison of the latest ESC, AHA/ACC/HRS, and CCS guidelines on the management of atrial fibrillation. Rev Cardiovasc Med 23:56. https://doi.ore/10.31083/j.rcm2302056\\u003c/li\\u003e\\n\\u003cli\\u003eFreitas-Ferraz AB, Rod\\u0026eacute;s-Cabau J, Junquera Vega L, Beaudoin J, O\\u0026apos;Connor K, Turgeon PY, Paradis JM, Ferreira-Neto A, Asmarats L, Champagne J, O\\u0026apos;Hara G, Bernier M.2020. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J 221:19-28. https://doi.ore/10.1016/j.ahj.2019.11.018\\u003c/li\\u003e\\n\\u003cli\\u003eFreeman JV, Varosy P, Price MJ, Slotwiner D, Kusumoto FM, Rammohan C, Kavinsky CJ, Turi ZG, Akar J, Koutras C, Curtis JP, Masoudi FA.2020. The NCDR Left Atrial Appendage Occlusion Registry. J Am Coll Cardiol 75:1503-1518. https://doi.ore/10.1016/j.jacc.2019.12.040\\u003c/li\\u003e\\n\\u003cli\\u003eHasnie AA, Parcha V, Hawi R, Trump M, Shetty NS, Ahmed MI, Booker OJ, Arora P, Arora G.2023. Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions. J Am Soc Echocardiogr 36:381-390. https://doi.ore/10.1016/j.echo.2022.12.023\\u003c/li\\u003e\\n\\u003cli\\u003eGu\\u0026eacute;rios EE, Schmid M, Gloekler S, Khattab AA, Wenaweser PM, Windecker S, Meier B.2012. Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation. Arq Bras Cardiol 98:528-36. https://doi.ore/10.1590/s0066-782x2012005000044\\u003c/li\\u003e\\n\\u003cli\\u003ePhillips KP, Walker DT, Humphries JA.2016. Combined catheter ablation for atrial fibrillation and Watchman\\u0026reg; left atrial appendage occlusion procedures: Five-year experience. J Arrhythm 32:119-26. https://doi.ore/10.1016/j.joa.2015.11.001\\u003c/li\\u003e\\n\\u003cli\\u003eKomatsu Y, Uno K, Otomo K, Nagata Y, Taniguchi H, Ogura K, Egami Y, Takayama K, Kakita K, Iesaka Y.2011. Atrial defibrillation threshold as a novel predictor of clinical outcome of catheter ablation for persistent atrial fibrillation. Europace 13:213-20. https://doi.ore/10.1093/europace/euq357\\u003c/li\\u003e\\n\\u003cli\\u003eReddy VY, Holmes D, Doshi SK, Neuzil P, Kar S.2011. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 123:417-24. https://doi.ore/10.1161/circulationaha.110.976449\\u003c/li\\u003e\\n\\u003cli\\u003eReddy VY, Gibson DN, Kar S, O\\u0026apos;Neill W, Doshi SK, Horton RP, Buchbinder M, Gordon NT, Holmes DR.2017. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol 69:253-261. https://doi.ore/10.1016/j.jacc.2016.10.010\\u003c/li\\u003e\\n\\u003cli\\u003eLam YY, Yip GW, Yu CM, Chan WW, Cheng BC, Yan BP, Clugston R, Yong G, Gattorna T, Paul V.2012. Left atrial appendage closure with AMPLATZER cardiac plug for stroke prevention in atrial fibrillation: initial Asia-Pacific experience. Catheter Cardiovasc Interv 79:794-800. https://doi.ore/10.1002/ccd.23136\\u003c/li\\u003e\\n\\u003cli\\u003ePhillips KP, Santoso T, Sanders P, Alison J, Chan JLK, Pak HN, Chandavimol M, Stein KM, Gordon N, Razali OB.2019. Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry. Int J Cardiol Heart Vasc 23:100358. https://doi.ore/10.1016/j.ijcha.2019.100358\\u003c/li\\u003e\\n\\u003cli\\u003eSievert H, Lesh MD, Trepels T, Omran H, Bartorelli A, Della Bella P, Nakai T, Reisman M, DiMario C, Block P, Kramer P, Fleschenberg D, Krumsdorf U, Scherer D.2002. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation 105:1887-9. https://doi.ore/10.1161/01.cir.0000015698.54752.6d\\u003c/li\\u003e\\n\\u003cli\\u003eYang L, Zhang X, Jin Q, Kong D, Zhang Y, Li M, Zhang L, Chen S, Pan W, Zhou D, Ge J.2021. Pericardial Effusion During the Perioperative Period for Left Atrial Appendage Closure. Front Cardiovasc Med 8:678460. https://doi.ore/10.3389/fcvm.2021.678460\\u003c/li\\u003e\\n\\u003cli\\u003eErhard N, Metzner A, Fink T.2022. Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications. Herzschrittmacherther Elektrophysiol 33:71-76. https://doi.ore/10.1007/s00399-021-00836-6\\u003c/li\\u003e\\n\\u003cli\\u003eCalkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d\\u0026apos;Avila A, de Groot N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, et al.2017. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14:e275-e444. https://doi.ore/10.1016/j.hrthm.2017.05.012\\u003c/li\\u003e\\n\\u003cli\\u003eAndrade JG, Khairy P, Guerra PG, Deyell MW, Rivard L, Macle L, Thibault B, Talajic M, Roy D, Dubuc M.2011. Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 8:1444-51. https://doi.ore/10.1016/j.hrthm.2011.03.050\\u003c/li\\u003e\\n\\u003cli\\u003eKuck KH, Brugada J, F\\u0026uuml;rnkranz A, Metzner A, Ouyang F, Chun KR, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque JP, Tondo C.2016. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 374:2235-45. https://doi.ore/10.1056/NEJMoa1602014\\u003c/li\\u003e\\n\\u003cli\\u003eSaw J, Tzikas A, Shakir S, Gafoor S, Omran H, Nielsen-Kudsk JE, Kefer J, Aminian A, Berti S, Santoro G, Nietlispach F, Moschovitis A, Cruz-Gonzalez I, Stammen F, Tichelb\\u0026auml;cker T, Freixa X, Ibrahim R, Schillinger W, Meier B, Sievert H, Gloekler S.2017. Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure With the Amplatzer Cardiac Plug. JACC Cardiovasc Interv 10:391-399. https://doi.ore/10.1016/j.jcin.2016.11.029\\u003c/li\\u003e\\n\\u003cli\\u003eWunderlich NC, Lorch GC, Honold J, Franke J, K\\u0026uuml;x H.2020. Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them. Curr Cardiol Rep 22:113. https://doi.ore/10.1007/s11886-020-01357-3\\u003c/li\\u003e\\n\\u003cli\\u003eOstermayer SH, Reisman M, Kramer PH, Matthews RV, Gray WA, Block PC, Omran H, Bartorelli AL, Della Bella P, Di Mario C, Pappone C, Casale PN, Moses JW, Poppas A, Williams DO, Meier B, Skanes A, Teirstein PS, Lesh MD, Nakai T, Bayard Y, Billinger K, Trepels T, Krumsdorf U, Sievert H.2005. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol 46:9-14. https://doi.ore/10.1016/j.jacc.2005.03.042\\u003c/li\\u003e\\n\\u003cli\\u003eHolmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P.2009. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534-42. https://doi.ore/10.1016/s0140-6736(09)61343-x\\u003c/li\\u003e\\n\\u003cli\\u003eSleiman JR, Lewis AJ, Perez EJ, Sanchez AM, Baez-Escudero JL, Navia JL, Asher CR, Cubeddu RJ.2021. Management of peri-device leak following left atrial appendage closure: A systematic review. Catheter Cardiovasc Interv 98:382-390. https://doi.ore/10.1002/ccd.29495\\u003c/li\\u003e\\n\\u003cli\\u003eAlkhouli M, Busu T, Shah K, Osman M, Alqahtani F, Raybuck B.2018. Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion: A Meta-Analysis. JACC Clin Electrophysiol 4:1629-1637. https://doi.ore/10.1016/j.jacep.2018.09.007\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Catheter ablation, Left atrial appendage occlusion, digital subtraction angiography, Propensity score matching\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3499375/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3499375/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eAssessing the Efficacy, Safety, and Economic Analysis of Transcatheter Closure of Left Atrial Appendage with Guidance of Perspective Directing Catheter Ablation Procedure.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThe study included patients with non-valvular atrial fibrillation who were admitted to the Seventh People's Hospital, Zhengzhou City, and underwent catheter ablation from March 2017 to April 2022. These patients were divided into two groups, the transesophageal echocardiography combined with fluoroscopy group (TEE group, n\\u0026thinsp;=\\u0026thinsp;73) and the fluoroscopy-guided group (DSA group, n\\u0026thinsp;=\\u0026thinsp;73), using propensity score matching. Perioperative and follow-up data were compared to assess the efficacy, safety and cost-effectiveness of fluoroscopy-guided left atrial appendage closure combined with catheter ablation.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eBoth groups of patients successfully completed catheter ablation and left atrial appendage occlusion, with similar procedure times (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05), indicating no statistical difference. In total, 4 patients experienced pericardial effusion and 1 patient experienced vagal reflex (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05), but there were no statistically significant differences. Regarding the occurrence of minimal pericardial effusion, there was a statistically significant difference between the DSA group and the TEE group (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), suggesting that the DSA group may have an advantage. Additionally, there were statistically significant differences between the DSA group and the TEE group in terms of hospitalization period and expenses (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). During the follow-up period, there were no statistically significant differences between the two groups in terms of atrial fibrillation recurrence, re-ablation, stroke/transient ischemic attack, and embolism. There were also no statistically significant differences in terms of all-cause mortality, all-cause rehospitalization, cardiovascular event rehospitalization, and major bleeding. Likewise, there were no statistically significant differences in terms of device displacement, residual shunting related to the device, and device-related thrombosis.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eFor the left atrial appendage occlusion combined with catheter ablation, the effectiveness and safety of DSA alone are not inferior to DSA combined with TEE guidance, and it has certain advantages in reducing hospital costs and length of stay.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Guided atrial fibrillation ablation combined with left atrial appendage occlusion by fluoroscopy alone: a propensity-matched study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2023-10-30 21:51:56\",\"doi\":\"10.21203/rs.3.rs-3499375/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4ee37746-a130-44c9-9a30-56017bca45b9\",\"owner\":[],\"postedDate\":\"October 30th, 2023\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-11-05T10:59:14+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2023-10-30 21:51:56\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3499375\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3499375\",\"identity\":\"rs-3499375\",\"version\":[\"v1\"]},\"buildId\":\"_2-kVJe1T_tPrBINL-cwx\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}