Key result
TEE-guided left atrial appendage closure was associated with a significantly lower rate of in-hospital major adverse events compared to ICE-guided closure (5.6% vs. 9.4%, p < 0.001).
Why the study?
Although ICE is a less invasive alternative to TEE for transcatheter LAAC, nationwide temporal trends, patient characteristics, and in-hospital outcomes comparing both modalities remained to be examined.
Does TEE-guided LAAC reduce major adverse events compared to ICE-guided LAAC in patients undergoing left atrial appendage closure?
Cohort
Yes
Does TEE-guided LAAC reduce major adverse events compared to ICE-guided LAAC in patients undergoing left atrial appendage closure?
TEE-guided LAAC is associated with lower in-hospital major adverse events, shorter length of stay, and lower costs compared to ICE-guided LAAC.
Answers are grounded in this paper and cite their sources.
TEE-guided LAAC was associated with fewer major adverse events; leaves open whether randomized trials will confirm superiority.
BACKGROUND: Transesophageal echocardiogram (TEE) is the preferred imaging modality to guide transcatheter left atrial appendage closure (LAAC). Intracardiac echocardiography (ICE) has evolved as a less invasive alternative to TEE. Several observational studies have shown similar success rates and perioperative complications between TEE and ICE for LAAC. OBJECTIVES: We sought to examine the temporal trends and patient characteristics of TEE versus ICE use in LAAC using a national database. We also evaluated hospital outcomes including periprocedural complications, mortality, and length of hospital stay. METHODS: This is a retrospective analysis of data from the National Readmission Database, collected from 2016 to 2018. The primary outcome was major adverse events (MAE) defined as in-hospital mortality, cardiac arrest, pericardial effusion with or without tamponade, pericardiocentesis or window pericardiocentesis and pericardial window, pericardial effusion and tamponade, and hemorrhage requiring transfusion. RESULTS: Trend analysis showed that TEE-guided LAAC increased from 96.6% in 2016 to 98.4% in 2018 (relative increase, 1.9%), while ICE-guided LAAC decreased from 3.4% to 1.6% during the same period (relative decrease, 53%, p for trend = 0.08). In the unmatched cohorts, the MAE was significantly lower in TEE-guided LAAC compared to ICE-guided LAAC (6.5% vs. 9.3%, p = 0.022). In the propensity score matching analysis, MAE remained significant (5.6% vs. 9.4%, p < 0.001). The incidence of pericardial effusion with or without tamponade remained significantly lower in the TEE group (2.3% vs. 5.8%, p < 0.001). Length of stay (3.4 vs. 1.9 days, p < 0.001) and hospitalization cost ($34,826 vs. $20,563, p < 0.001) remained significantly lower for TEE-guided LAAC. CONCLUSIONS: Compared to ICE, the incidence of MAE was significantly lower for TEE-guided LAAC, driven mainly by less pericardial effusion events. Large-scale randomized trials are needed to confirm the findings of the current and previous studies.
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Morcos et al. (2022) conducted a cohort in Left atrial appendage closure (LAAC). Transesophageal echocardiogram (TEE) guided LAAC vs. Intracardiac echocardiography (ICE) guided LAAC was evaluated on Major adverse events (MAE) defined as in-hospital mortality, cardiac arrest, pericardial effusion with or without tamponade, pericardiocentesis or window pericardiocentesis and pericardial window, pericardial effusion and tamponade, and hemorrhage requiring transfusion (p=<0.001). TEE-guided left atrial appendage closure was associated with a significantly lower rate of in-hospital major adverse events compared to ICE-guided closure (5.6% vs. 9.4%, p < 0.001).
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