Key result
Intracardiac echocardiography guidance for left atrial appendage occlusion achieved 100% procedural success and significantly reduced median procedure time to 45 minutes compared to 54 minutes with transesophageal echocardiography.
Why the study?
TOE is the gold standard for guiding percutaneous LAAO, but ICE appears to be a potential alternative.
Does intracardiac echocardiography (ICE) guidance improve procedural success and safety compared to transesophageal echocardiography (TOE) in patients undergoing percutaneous left atrial appendage occlusion?
Cohort (n=23)
Open-label
Alternating assignment
No
Does intracardiac echocardiography (ICE) guidance improve procedural success and safety compared to transesophageal echocardiography (TOE) in patients undergoing percutaneous left atrial appendage occlusion?
Absolute Event Rate: 45% vs 54%
p-value: p=0.02
Intracardiac echocardiography is a safe and effective alternative to transesophageal echocardiography for guiding left atrial appendage occlusion, offering shorter procedure times while avoiding the need for general anesthesia.
May shorten left atrial appendage occlusion procedures with intracardiac echocardiography; leaves open randomized confirmation of safety versus transesophageal echocardiography.
INTRODUCTION: Percutaneous occlusion of the left atrial appendage (LAAO) is becoming an extensively used method of stroke prevention in individuals with contraindications to oral anticoagulants. Transesophageal echocardiography (TOE) is the gold standard for LAAO guiding, but intracardiac echocardiography (ICE) appears to be a potential alternative. AIM: To compare the LAAO procedure guided by TOE or ICE with respect to procedural success and safety. MATERIAL AND METHODS: TOE-guided LAAO was performed in 12 patients and ICE-guided LAAO in 11 patients. ICE was performed using an 8F AcuNav probe and the ACUSON SC2000 system. For LAAO the Amplatzer Amulet was used. After 1 month TOE was performed. RESULTS: = 0.03). There were no statistically significant differences in the results between TOE and ICE groups in follow-up assessments. CONCLUSIONS: LAAO using the Amplatzer Amulet may be successfully and safely guided by ICE. ICE offered shorter procedure time and similar results irrespectively of left atrial appendage anatomy compared to TOE guidance.
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Streb et al. (2019) conducted a cohort in Atrial fibrillation with contraindications to oral anticoagulants (n=23). Intracardiac echocardiography (ICE) guidance vs. Transesophageal echocardiography (TOE) guidance was evaluated on Procedure time (minutes) (p=0.02). Intracardiac echocardiography guidance for left atrial appendage occlusion achieved 100% procedural success and significantly reduced median procedure time to 45 minutes compared to 54 minutes with transesophageal echocardiography.
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