Key result
ICE-guided LAAO matches TEE for procedural success and complication rates while avoiding general anesthesia.
Why the study?
Intracardiac echocardiography is an alternative to transesophageal echocardiography for imaging guidance during left atrial appendage occlusion, prompting a synthesis of contemporary evidence.
Does intracardiac echocardiography guidance provide comparable procedural outcomes to transesophageal echocardiography in patients with atrial fibrillation undergoing left atrial appendage occlusion?
Does intracardiac echocardiography guidance provide comparable procedural outcomes to transesophageal echocardiography in patients with atrial fibrillation undergoing left atrial appendage occlusion?
Intracardiac echocardiography is a viable alternative to transesophageal echocardiography for guiding LAAO, offering the benefits of conscious sedation and reduced fluoroscopy time, though it requires specialized training and carries specific vascular risks.
Supports ICE-guided LAAO under conscious sedation in observational data; leaves open randomized confirmation versus TEE.
Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography for imaging guidance during left atrial appendage occlusion (LAAO) in patients with atrial fibrillation with intolerance to long-term oral anticoagulation. This narrative review synthesizes contemporary evidence on ICE-guided LAAO. Across observational studies, ICE provides real-time high-resolution imaging enabling accurate trans-septal puncture, device sizing, and deployment under conscious sedation. Procedural success, peri-device leak, and device-related thrombus rates appear comparable between ICE- and TEE-guided LAAO, while ICE may also shorten fluoroscopy time and avoid general anesthesia. Challenges with ICE include operator learning curve, need for additional venous access and intracardiac catheter manipulation, that may add to risks like pericardial effusions, vascular complications and higher costs. Emerging 3D/4D ICE and artificial-intelligence-integrated computed tomographic planning may improve efficiency and allow for combined ablation and LAAO procedures. Further randomized controlled trials and cost-effectiveness studies are needed to define the role of ICE-first approach.
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Toquica et al. (2026) conducted a review in Atrial fibrillation with intolerance to long-term oral anticoagulation. Intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO) vs. Transesophageal echocardiography (TEE)-guided LAAO was evaluated. Intracardiac echocardiography-guided LAAO appears comparable to TEE-guided LAAO for procedural success, peri-device leak, and device-related thrombus rates, while avoiding general anesthesia.
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