Intracardiac Echocardiography Guidance for Percutaneous Transcatheter Closure of Atrial Septal Defects ― Nationwide Registry Data Analysis ―
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Key result
Intracardiac echocardiography guidance for atrial septal defect closure yielded similar success to transesophageal echocardiography (99.2% vs 99.0%) but reduced general anesthesia use (2.9% vs 92.4%).
Why the study?
TEE has been used for percutaneous ASD closure, but ICE guidance has recently been introduced.
Does intracardiac echocardiography guidance compared to transesophageal echocardiography guidance provide similar success and complication rates for percutaneous transcatheter closure of atrial septal defects?
Population
2,859 consecutive cases undergoing percutaneous ASD closure in Japan
Comparison
ICE guidance vs TEE guidance vs TEE plus ICE guidance
Design
Nationwide registry-based study
Authors
Discussion
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Member takes
Implication
ICE feasible for select ASD cases in registry data; leaves open randomized confirmation before broader adoption.
Study Design
Type
Observational (n=2,859)
Multicenter
Yes
Structured PICO
Does intracardiac echocardiography guidance compared to transesophageal echocardiography guidance provide similar success and complication rates for percutaneous transcatheter closure of atrial septal defects?
P
Population
2,859 patients (median age 58, 62.8% female) undergoing percutaneous transcatheter atrial septal defect closure in a nationwide Japanese registry.
E
Exposure
Intracardiac echocardiography (ICE) guidance
C
Comparator
Transesophageal echocardiography (TEE) guidance or TEE plus ICE guidance
O
Outcome
Procedural success rate
Main Result
Absolute Event Rate: 99.2% vs 99%
p-value: p=0.054
ICE guidance for percutaneous ASD closure is as feasible and safe as TEE guidance, while significantly reducing the need for general anesthesia, though it is associated with longer fluoroscopy times.
Limitations
- Retrospective observational design with potential selection bias.
- Extremely low complication rates suggest mild complications may have been overlooked or underreported.
- No information available about arrhythmic complications in the registry.
- Propensity score-matched comparison was not performed due to the small number of cases in the ICE group.
- Lack of data on preoperative imaging evaluations and specific ASD morphology (e.g., septal malalignment).
Cite This Study
Tanabe et al. (2023) conducted an observational in Atrial Septal Defect (n=2,859). Intracardiac echocardiography (ICE) guidance vs. Transesophageal echocardiography (TEE) guidance was evaluated on Procedural success (p=0.054). Intracardiac echocardiography guidance for atrial septal defect closure yielded similar success to transesophageal echocardiography (99.2% vs 99.0%) but reduced general anesthesia use (2.9% vs 92.4%).
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