Key result
ICE-TEE offers a viable alternative to guide LAAC without requiring general anesthesia.
Why the study?
TEE-guided LAAC typically requires general anesthesia while standard ICE is not yet standardized and may yield inferior image quality, prompting evaluation of alternative minimalist imaging approaches like ICE via the esophageal route.
Is ICE-TEE a viable alternative imaging modality to guide left atrial appendage closure without general anesthesia in patients with non-valvular atrial fibrillation?
Is ICE-TEE a viable alternative imaging modality to guide left atrial appendage closure without general anesthesia in patients with non-valvular atrial fibrillation?
ICE-TEE represents a potential 'minimalist approach' alternative to standard TEE or ICE for guiding left atrial appendage closure without the need for general anesthesia.
May enable anesthesia-free LAA closure guidance; leaves open need for randomized validation before practice change.
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appendage (LAA) is the most likely source of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Left atrial appendage closure (LAAC) represents an effective alternative to NOAC in patients with NVAF. Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in addition to standard fluoroscopy to guide LAAC. TEE-guided LAAC usually requires general anesthesia. The ICE technique is a "minimalist approach", without general anesthesia, but ICE imaging techniques are not yet simplified and standardize, and the ICE may result in inferior image quality compared with that of TEE. Another "minimalist approach" can be the use of ICE via the esophageal route (ICE-TEE), that jet is validated to identify the presence of LAA thrombi in patients and to perform other procedures. In our cath laboratory ICE-TEE to guide LAAC is used in some complex patients. Indeed, our single center experience suggests that ICE-TEE could be a good alternative imaging technique to guide LAAC procedure without general anesthesia.
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Laterra et al. (2023) conducted a review in Non-valvular atrial fibrillation (NVAF). Intracardiac echocardiography via the esophageal route (ICE-TEE) guided LAAC vs. Transesophageal echocardiography (TEE) or standard intracardiac echocardiography (ICE) was evaluated. Intracardiac echocardiography via the esophageal route (ICE-TEE) may serve as a viable alternative imaging technique to guide left atrial appendage closure without requiring general anesthesia.
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