Intracardiac echocardiography to guide LAAO achieved similar procedural success (98% vs 100%) and complication rates (p=0.590) compared to transesophageal echocardiography.
Cohort (n=224)
No
Does intracardiac echocardiography from the left atrium under local anesthesia provide similar safety and efficacy compared to transesophageal echocardiography under general anesthesia for guiding left atrial appendage occlusion?
ICE from the left atrium under local anesthesia is as safe and effective as TEE under general anesthesia for guiding LAAO, while reducing procedure time and contrast use.
Absolute Event Rate: 98% vs 100%
BACKGROUND: There is a paucity of randomized data regarding the safety and efficacy of the use of intracardiac echocardiography (ICE) from the left atrium (LA) to guide left atrial appendage occlusion (LAAO) procedures under local anesthesia using either of the available devices. HYPOTHESIS: The aim of this study was to compare the efficacy and safety of ICE from the LA with transesophageal echocardiography (TEE) for guidance during transcatheter LAAO procedures. METHODS: Single-center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Watchman device. Procedures were guided by ICE from the LA with local anesthesia (n = 175) or TEE under general anesthesia (n = 49). Efficacy outcomes were procedural success and peri-device leaks 6 weeks after LAAO. The safety outcome was a composite of procedure-related complications. RESULTS: Procedural success was similar between groups: 100% in the TEE-guided group, and 98% in the ICE-guided group. Procedure-related complications such as death, embolism, migration, or major vascular complications occurred similarly between groups (p = 0.590). The rate and degree of peri-device leaks or presence of a thrombus on the device did not differ between groups on follow-up CT. Turnover time in the catheter laboratory and use of contrast agent were reduced with ICE. CONCLUSIONS: ICE in the left atrium to guide LAAO procedures appears to be as effective and safe as TEE. There was no increase in procedure-related complications, whatever the device used. ICE resulted in similar procedural success while decreasing procedure time and requiring only local anesthesia.
Pommier et al. (Wed,) conducted a cohort in Patients undergoing left atrial appendage occlusion (n=224). Intracardiac echocardiography (ICE) from the left atrium vs. Transesophageal echocardiography (TEE) was evaluated on Procedural success. Intracardiac echocardiography to guide LAAO achieved similar procedural success (98% vs 100%) and complication rates (p=0.590) compared to transesophageal echocardiography.