Key result
Intra-cardiac echocardiography guidance for Watchman FLX left atrial appendage occlusion was not inferior to transesophageal echocardiography, with 98.7% vs 98.5% procedural success.
Why the study?
The study aimed to compare the peri-procedural success and complication rate of ICE- versus TEE-guided LAA occlusion with a Watchman FLX device.
Does intra-cardiac echocardiography guidance improve procedural success or reduce complications compared to transesophageal echocardiography in patients undergoing left atrial appendage occlusion with a Watchman FLX device?
Observational (n=772)
Yes
Does intra-cardiac echocardiography guidance improve procedural success or reduce complications compared to transesophageal echocardiography in patients undergoing left atrial appendage occlusion with a Watchman FLX device?
Absolute Event Rate: 98.7% vs 98.5%
Intra-cardiac echocardiography guidance for left atrial appendage occlusion with a Watchman FLX device is safe and effective, offering comparable procedural success to transesophageal echocardiography.
Supports ICE as feasible alternative for Watchman FLX LAAO; hypothesis-generating, requiring RCTs before practice change.
This study aimed to compare the peri-procedural success and complication rate within a large registry of intra-cardiac echocardiography (ICE)- vs. transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) procedures with a Watchmann FLX device. Data from 772 LAAO procedures, performed at 26 Italian centers, were reviewed. Technical success was considered as the final implant of a Watchmann FLX device in LAA; the absence of pericardial tamponade, peri-procedural stroke and/or systemic embolism, major bleeding and device embolization during the procedure was defined as a procedural success. One-year stroke and major bleeding rates were evaluated as outcome. ICE-guided LAA occlusion was performed in 149 patients, while TEE was used in 623 patients. Baseline characteristics were similar between the ICE and TEE groups. The technical success was 100% in both groups. Procedural success was also extremely high (98.5%), and was comparable between ICE (98.7%) and TEE (98.5%). ICE was associated with a slightly longer procedural time (73 ± 31 vs. 61.9 ± 36 min, p = 0.042) and shorter hospital stay (5.3 ± 4 vs. 5.8 ± 6 days, p = 0.028) compared to the TEE group. At one year, stroke and major bleeding rates did not differ between the ICE and TEE groups. A Watchmann FLX device showed high technical and procedural success rate, and ICE guidance does not appear inferior to TEE.
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Pastormerlo et al. (2023) conducted an observational in Left atrial appendage occlusion (n=772). Intra-cardiac echocardiography (ICE) guidance vs. Transesophageal echocardiography (TEE) guidance was evaluated on Procedural success (absence of pericardial tamponade, peri-procedural stroke/systemic embolism, major bleeding, and device embolization). Intra-cardiac echocardiography guidance for Watchman FLX left atrial appendage occlusion was not inferior to transesophageal echocardiography, with 98.7% vs 98.5% procedural success.