A Prospective Comparison of Cardiac Imaging Using Intracardiac Echocardiography With Transesophageal Echocardiography in Patients With Atrial Fibrillation

Abstract

Background-The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study evaluatedthe concordance of intracardiac echocardiography (ICE) with transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF). Methods and Results-Patients with AF undergoing right heart catheterization underwent left atrium (LA) and interatrial septal (IAS) imaging by TEE and ICE. A blinded comparison of the 2 modalities was performed at a core laboratory. Ninety-five patients aged 58Ϯ12 years completed the study. The LA was profiled in all patients with both techniques, and concordance for image quality was 96%. LA appendage (LAA) imaging was achieved in 85% with ICE and 96% with TEE. There was no difference in the presence of spontaneous echo contrast between ICE and TEE during LA imaging, but there was a trend toward a greater incidence in the LAA with TEE (Pϭ0.109). Intracardiac thrombus was uncommonly seen (TEE, 6.9%; ICE, 5.2%). The concordance for the presence or absence of thrombus was 97% in the LA and 92% in the LAA, but the latter was detected more frequently with TEE. IAS imaging was achieved in 91% with ICE and in 97% with TEE (Pϭ0.177). Concordance for patent foramen ovale and atrial septal aneurysms was 100% and 96%, respectively. A negative ICE examination was associated with absence of dense echo contrast or thrombus on TEE in 86%. Conclusions-This

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

“…Patients in whom discontinuation of systemic anticoagulation is being considered should consider undergoing continuous ECG monitoring to screen for asymptomatic AF/AFL/AT. [406,407], other studies have reported that CT scanning can identify left atrial appendage thrombi with good sensitivity but moderate specificity [408]. Consistent with these findings, the members of this task force do not recommend that ICE or CT imaging be used to screen for LA thrombi in patients who are at high risk of stroke, and TEE is warranted.…”

“…The heparin dose should be adjusted to maintain an ACT of at least 300-350 s throughout the procedure. Approximately one third of the task force uses a target ACT of 350 s, especially in patients with spontaneous echo contrast or significant atrial enlargement [402,407,411].…”

Utilization and Adverse Outcomes of Percutaneous Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation in the United States

“…One alternative to TEE is the use of intracardiac echocardiography (ICE), which has proven to be useful in a variety of interventional procedures. 8 The majority of data on the safety of percutaneous LAA closure comes from selected centers and operators with considerable expertise in the procedure. Outcomes attained in the context of clinical trials might not be reproducible in real-world clinical practice.…”

Technological Improvements in Cardiac Thrombus Diagnosis

“…ICE can provide multiple views and detailed LAA imaging which facilitates detection of potential thrombi [39,40]. Although ICE is less sensitive than TEE for thrombus detection [41], it can serve as a complementary method, especially when equivocal TEE findings merit further evaluation. However, because ICE is an invasive procedure, it is not typically used in daily practice and is mainly reserved for planned interventional cardiac procedures in a catheterization laboratory setting.…”