Efficacy and safety of transcatheter left atrial appendage closure guided by transoesophageal echocardiography using standard and micro TEE probes: a single-center retrospective study

Background Transcatheter left atrial appendage closure (T-LAAC) represents an effective alternative to long-term anticoagulation in patients with atrial fibrillation (AF) and contraindications to oral anticoagulants. Transoesophageal echocardiography (TEE) is the standard imaging modality for procedural guidance, while micro-TEE may allow adequate imaging under conscious sedation, potentially simplifying procedural workflow. This study aimed to evaluate the efficacy and safety of micro-TEE compared with standard TEE guidance during T-LAAC. Methods Single-center, retrospective study, all consecutive patients undergoing T-LAAC between June 2021 and August 2024. Patients were stratified according to intraprocedural imaging guidance (micro-TEE vs. standard TEE). Baseline characteristics, procedural data, and short-term outcomes were analyzed. A subgroup analysis excluding patients who underwent simultaneous combined atrial fibrillation ablation procedures was performed to reduce confounding. Results A total of 47 patients were considered; one was excluded due to poor view in both imaging modalities, for a total of 46 patients. 38 procedures were performed under standard TEE and 8 under micro-TEE guidance. No differences in baseline clinical and echocardiographic characteristics were found. Procedural success was similar, with one failure in the standard TEE group due to the unavailability of the right size of the closure device. No significant differences were observed in periprocedural complications, including mild pericardial effusion, cardiac tamponade, device-related thrombosis, or significant peridevice leak. Micro-TEE guidance was associated with a significantly shorter procedural time (153 vs. 175 min, p = 0.040) and a lower rate of orotracheal intubation, without increases in fluoroscopy time, radiation exposure, or contrast use. This data was confirmed even after considering only isolated T-LAAC procedures, excluding simultaneous combined AF ablation-T-LAAC procedures (143 vs. 160 min, p = 0.042). At 1-month follow-up, the micro-TEE group did not show an increased complication rate. Conclusion The use of micro-TEE during T-LAAC procedures did not show a significant difference in procedural success rate and was not associated with an increased complication rate compared with standard TEE guidance. The use of micro-TEE showed a reduction in total procedural time, partly due to the reduced need for OTI, without an increase in radiation exposure, fluoroscopy time, and contrast use.